Cholesterol-lowering therapy may retard the progression of diabetic nephropathy

Abstract

SummaryThere is experimental evidence to suggest that hypercholesterolaemia may play a pathogenetic role in progressive glomerular injury. We investigated the effect of cholesterol-lowering therapy on the progression of diabetic nephropathy in 34 patients with non-insulin-dependent diabetes mellitus. Patients were randomly assigned in a single-blind fashion to treatment with either lovastatin, an HMG CoA reductase inhibitor (n = 16; mean dose 30.0 + 12.6 mg/day) or placebo (n = 18) for 2 years. Renal function was assessed by serially measuring the serum creatinine, glomerular filtration rate (using CrSl-EDTA), and 24-h urinary protein excretion. Lovastatin treatment was associated with significant reductions in total cholesterol (p < 0.001), LDL-cholesterol (p < 0.001) and apo B (p < 0.01), the reductions at 24 months being 26, 30 and 18 %, respectively. Beneficial effects on serum triglyceride, HDL-cholesterol and apo AI levels were also observed. Lp(a) showed no significant change in both groups. Glomerular filtration rate deteriorated significantly in the placebo group after 24 months (p < 0.025) but showed no significant change in the lovastatin-treated patients. The increase in serum creatinine was statistically significant (p < 0.02) in placebo-treated patients at 12 and 24 months, and in the lovastatin group after 24 months. Twenty-four hour urinary protein excretion increased in both groups (p < 0.05). Lovastatin treatment was not associated with significant elevations in liver or muscle enzymes. We conclude that effective normalisation of hypercholesterolaemia may retard the progression of diabetic nephropathy. [Diabetologia (1995) 38: 604-609]

Effect of Statins on Kidney Disease Outcomes: A Systematic Review and Meta-analysis

“…Twenty-nine trials with 4,968 participants reported data regarding the effects of statins on changes in proteinuria or albuminuria. Of these, 11 studies with a total of 2,833 participants provided data for urinary protein excretion 12,38,[46][47][48][49]51,58,62,67,73 ; 12 studies with 1,227 participants, urinary albumin excretion [43][44][45]52,54,55,63,[77][78][79][80][81] ; 5 studies with 788 participants, ACR 60,71,76,82 ; and 1 study with 120 participants, PCR. 69 The standardized mean difference in change in proteinuria or albuminuria was statistically significant at 20.65 (95% CI, 20.94 to 20.37) compared with the placebo or usual-care control groups, with substantial .…”