Attenuation Of The Cardiorenal Syndrome
Important bidirectional interactions exist between heart and kidney disease. Acute or chronic dysfunction of the heart or kidneys can induce acute or chronic dysfunction in the other organ. For instance, patients with heart failure with a deteriorating glomerular filtration rate have higher mortality. Inversely, patients with CKD have an increased risk of heart failure, which is responsible for up to 50 percent mortality. This vicious liaison is known as the CRS. Oxidative stress, endothelial dysfunction, and vascular inflammation are pathophysiological factors that are strongly related to the CRS. The pleiotropic effects of statins on cardiovascular processes, particularly their anti-inflammatory/antioxidant potential and capacity to improve nitric oxide bioavailability, support a benefit on the progression of chronic kidney and heart failure.
What Are Acute Kidney Injury And Chronic Kidney Disease
Before we look at some of the medications that can cause kidney damage, lets understand the different types of kidney dysfunction. Drug-induced nephrotoxicity can contribute to two types of kidney disease – acute kidney injury and chronic kidney disease .
Acute Renal Failure
Acute kidney injury develops rapidly. It can range from minor to severe renal dysfunction requiring renal replacement therapy . Doctors manage acute kidney injury by identifying and treating the underlying cause while minimizing associated complications. Acute kidney injury is usually reversible.
Chronic Kidney Disease
Chronic kidney disease develops gradually for months or even years. It is usually the result of a chronic condition such as diabetes or high blood pressure. Most patients with CKD dont have any symptoms in the early stages, and the condition is typically discovered incidentally on routine testing for unrelated problems. Medical treatment can slow the progress of renal dysfunction. However, keep in mind that CKD is irreversible and eventually leads to end-stage renal disease with the need for dialysis or a kidney transplant.
Types of Kidney Damage
Statins And A Possible Risk Of Acute Kidney Injury
1 November 2013
Medsafe has identified a possible signal of acute kidney injury with the use of high-dose statins following a review of published literature. Myopathy or rhabdomyolysis is a well-known adverse effect of statin therapy, with acute kidney injury occurring secondary to these symptoms. Recent studies however have suggested that there is a risk of acute kidney injury occurring without prior or concurrent onset of myopathy or rhabdomyolysis.
The Centre for Adverse Reactions Monitoring has received a total of 38 reports which fulfil the criteria for acute kidney injury with statins. Of these, 24 also report rhabdomyolysis or creatine kinase elevations, which are suggestive of muscle problems. Statins have been placed on Medsafe’s medicines monitoring scheme because we are seeking additional information on whether or not acute kidney injury occurs in the absence of muscle injury.
Acute kidney injury is defined in different ways, from acute renal failure with tubular necrosis or unspecified, through to need for renal replacement therapy such as haemodialysis, peritoneal dialysis or kidney transplantation.
Statins are indicated for patients at high risk of coronary heart disease or with exising coronary heart disease and patients with hyperlipidaemia.
The overall benefit-risk balance of statins remains positive.
Update to Original Communication
1 August 2014
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Statins And The Effect On Kidney Function
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What Are The Side Effects Of Atorvastatin
With any medication, there are risks and benefits. Even if the medication is working, you may experience some unwanted side effects.
Contact your doctor immediately if you experience any of the following:
- Dark brown urine, severe muscle weakness or pain, fever, tiredness
- Yellowing of the eyes or skin, pale stool, dark urine
The following side effects may get better over time as your body gets used to the medication. Let your doctor know immediately if you continue to experience these symptoms or if they worsen over time.
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So How Do You Avoid Kidney Damage From Drugs
According to research, most adverse events due to medications occur due to errors with a prescription, lack of monitoring of the medication and errors in taking the drug appropriately.
But thats not always the case. Numerous drugs have been fast-tracked by the FDA into the pharmaceutical market, only to be yanked off the shelves or denied prescription after adverse effects, even deaths, were reported.
Even OTC drugs that seem harmless, like NSAIDs have been shown to have a dark side.
The best advice is to consider whether you really need to take these medications. When possible choose natural remedies so you can minimize your use of medications overall and the dangers they carry.
When taking medications make sure you drink adequate fluids to prevent dehydration and promote optimal kidney filtering.
Editors note: Uncover the myths surrounding hypertension and get the truth about easy, effective strategies for controlling blood pressure. Click here to discover Natural Ways to Reverse and Prevent Hypertension!
Should The Use Of Cholesterol
Although LDL-C is widely used in estimating future CV risk in the general population, kidney function is not incorporated in current risk calculators despite the fact that reduced GFR confers increased CV risk. The prescription of statins using standard absolute risk algorithms may therefore result in many patients with renal impairment who would benefit from statins not receiving this therapy.
Among advanced-stage CKD patients, the magnitude of risk associated with LDL-C levels decreases with progression of the stage of CKD. For dialysis patients with the lowest level of LDL-C and total cholesterol, the all-cause and CV mortality remains high., Hence, the evidence argues against the use of LDL-C to identify patients requiring treatment, but rather suggests consideration of absolute risk for coronary events . As CKD itself is a risk factor for CV events, a reduced treatment threshold may be appropriate. The most recent KDIGO guidelines take this analysis into account in recommending the routine use of lipid lowering with a statin ± ezetimibe regimen in all people over the age of 50 with CKD.
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Drug Dosages In Patients With Ckd
Some dosage modifications for some of the statins need to be carried out as GFR levels fall . Atorvastatin and it metabolites are excreted mostly in bile, and urinary excretion is low, so dosages do not have to be modified as GFR levels fall . Atorvastatin can be given in dosages up to 80 mg/d in patients who are on both hemodialysis and chronic ambulatory peritoneal dialysis . In patients who are on hemodialysis, the dosage can be given before or after dialysis .
Drug dosages for dyslipidemias in patients with chronic kidney disease
Fluvastatin is almost completely metabolized by the liver with < 5% excreted in the urine . Therefore, it also can be given in dosages up to 80 mg/d even in patients who are on hemodialysis and CAPD .
Data on pravastatin are less certain with respect to declining GFR levels, and pravastatin and its active metabolites may accumulate . Therefore, it has been recommended that dosages of pravastatin start at 10 mg/d and higher doses be used cautiously when the GFR is < 50 ml/min per 1.73 m2 . However, as noted in the Pravastatin Pooling Project, 40 mg was used down to 30 ml/min per 1.73 m2, and there were no adverse effects from this .
Rosuvastatin is 90% excreted unchanged in the feces and only 10% in urine . When the GFR is < 30 ml/min per 1.73 m2, it has been found to accumulate, so it should not be given at a dosage of > 10 mg with this degree of CKD .
Get A Prescription For Atorvastatin Online
Did you know you can get a refill prescription for Lipitor online* without having to go to a providers office? With GoodRx Care, you can connect with a licensed healthcare provider for a virtual visit from the comfort and privacy of your home. And with GoodRx Gold Mail Delivery, you can order your Lipitor prescription and have it mailed right to your door.
Connect with a provider within minutes
Pick up your prescription at your pharmacy or get it discreetly delivered
No insurance needed
* Lipitor is a refill-only medication. We cant start you on Lipitor if you dont have an existing prescription.
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Kidney Damage From Rhabdomyolysis
Another dangerous side effect of Lipitor is rhabdomyolysis, which is a type of muscle disease that can cause acute kidney failure. Rhabdomyolysis occurs when muscle fibers break down very rapidly and release protein into the bloodstream. When this blood is filtered by the kidneys, the protein clogs the kidneys and causes irreversible damage.
Healthcare Professionals Should Offer Statins To Millions Of People With Chronic Kidney Disease This Will Help To Manage Their Increased Risk Of Cardiovascular Disease Says Nice
27 July 2017
The new NICE standard lists Atorvastatin as the preferred statin to offer patients because it is both clinically and cost effective.
Research has shown there is a clear link between reduced kidney function and CVD.
Chronic kidney disease is a long-term condition where the kidneys no longer work as well as they used to. It is associated with ageing.
Around 2.6 million people in England have CKD and approximately 60,000 people die prematurely each year because of the disease.
Professor Gillian Leng, deputy chief executive at NICE, said:We know that a high number of people with long-term kidney problems will develop cardiovascular disease. This means they have an increased risk of suffering a fatal heart attack or stroke.
It is important for healthcare professionals to speak to patients about their treatment options. The effectiveness of statins is now well proven, as is their long term safety. They may appeal to a lot of people who are at risk.
The effectiveness of statins is now well proven, as is their long term safety. They may appeal to a lot of people who are at risk.
Professor Gillian Leng, deputy chief executive at NICE
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How Should I Take Amlodipine And Atorvastatin
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Take this medicine at the same time each day, with or without food.
Do not break an amlodipine and atorvastatin tablet. Tell your doctor if you have trouble swallowing the pill.
You may need to stop using amlodipine and atorvastatin for a short time if you have:
a severe infection or illness or
surgery or a medical emergency.
You will need frequent medical tests.
You may need to take amlodipine and atorvastatin on a long-term basis. Keep using this medication even if you feel fine. High blood pressure or high cholesterol often have no symptoms.
Amlodipine and atorvastatin is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.
Store at room temperature away from moisture and heat.
Cholesterol Levels In Dialysis Patients
In a study of dialysis patients, those with higher cholesterol levels had lower mortality than those with low cholesterol.51 Yet the authors claimed that the inverse association of total cholesterol level with mortality in dialysis patients is likely due to the cholesterol-lowering effect of systemic inflammation and malnutrition, not to a protective effect of high cholesterol concentrations. Keeping an eye on further funding opportunities, the authors concluded: These findings support treatment of hypercholesterolemia in this population.
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Evidence For Decrease In Cvd With Treatment Of Dyslipidemias In Diabetes
Several large, prospective, randomized studies have demonstrated marked cardiovascular benefits with the treatment of dyslipidemias in patients with and without diabetes, and are reviewed only briefly here. Most of the studies that have examined these treatment effects on people with diabetes used subset analyses of this group that were part of the original study design, and all but two used statins as the intervention: The Helsinki Heart Study and the Veterans Administration High-Density Lipoprotein Cholesterol Intervention Trial , which used gemfibrozil .
Among six primary prevention trials in which diabetes subgroup analyses were performed , five of six showed benefit on CVD, but statistically significant benefit was found only in the very large HPS and ASCOT-LLA . In fact, in the PROSPER study of elderly patients, there was a trend toward harm with pravastatin use . A formal meta-analysis of these trial results showed a pooled relative risk for CVD events with lipid-lowering therapy in patients with diabetes of 0.78 .
Frequently Asked Questions About Atorvastatin
Do you have to take atorvastatin at night?
Unlike other statins, atorvastatin can be taken at any time of the day. This is because atorvastatin stays in your body longer than short-acting statins. Other statins work better when taken at night because that is when the body makes the most cholesterol.
Can you drink alcohol while taking atorvastatin ?
Drinking alcohol while taking atorvastatin can increase your risk of side effects, especially those affecting your muscles and liver. Take care to minimize the amount of alcohol you drink while taking atorvastatin .
What foods should you avoid when taking atorvastatin ?
Atorvastatin works best when you take it along with having a healthy, balanced diet. Foods high in cholesterol or fats should be consumed in moderation. Also, avoid grapefruit as it can interfere with how your body processes atorvastatin and increase your risk of side effects .
Do you need to take atorvastatin with food?
Atorvastatin can be taken with or without food.
Does atorvastatin have more or less side effects than other statins?
Atorvastatin is a stronger statin. People tend to have more side effects with it, though those side effects may go away at lower doses. Talk with your doctor about which statin is right for you.
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Evidence For Decrease In Cvd With Treatment Of Dyslipidemias In Ckd
Although it is tempting to extrapolate the previously mentioned studies to patients with CKD, it must be emphasized that most of these studies had known CKD as an exclusion criterion, so direct data showing benefit of statin therapy on CVD in patients with CKD are limited. The HPS had an upper exclusion for serum creatinine of 2.26 mg/dl . They did perform a subgroup analysis of patients with elevated creatinine and normal creatinine, using levels of 1.24 mg/dl in women and 1.47 mg/dl in men as cutoff values . For individuals without diabetes, the relative risk reductions were 21.4% for those with normal creatinine levels and 29.6% for those with elevated creatinine levels , both being statistically significant . For individuals with diabetes, the relative risk reductions were 18.4% for those with normal creatinine levels and 22.6% for those with elevated creatinine levels , with the reduction in the normal creatinine group being statistically significant but that in the elevated creatinine group being only borderline significant. It should be noted that for the group without diabetes, overall, those with elevated creatinine levels had a 47% increased risk for CVD events compared with those with normal creatinine levels, and for the group with diabetes, this increased risk was 80.1% .
Changes In The Lipid Profile
The time course of LDL-C is shown in Fig. 2. LDL-C decreased significantly and rapidly in Group A and the level of LDL-C fulfilled the protocol requirement. The final average dosage of atorvastatin at the end of follow-up period was 10.5 mg. In contrast, the conventional therapy slowly but significantly decreased in serum LDL-C in Group C compared to Group A. In Group C, the LDL-C concentration ended up to 116.0 mg/dl. While this level, met recommendation of Japanese Society of Nephrology, it did not reach the target level of 100 mg/dl. TG was significantly reduced only by atorvastatin, but not conventional drugs . Atorvastatin lowered serum HDL levels , whereas control treatment reduced it by 2.9 mg/dl. The difference on the HDL lowering effects between two groups did not reach statistical significance. In addition, it was found that serum HDL levels were not associated with GFR in our study .
Time course of LDL-C concentration. Solid line and dashed line represent Group A and B , respectively. Dotted line represents recommended value of Japanese society of nephrology. Error bars represent standard deviation. *p < 0.05: each point value vs. baseline value, #p < 0.05: group A vs group C
Time course of serum TG. Solid line and dashed line represent Group A and C , respectively. Error bars represent standard deviation. *p < 0.05: each points value vs. baseline value, #p < 0.05: Group A vs. Group C
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Cholesterol Drugs May Increase Risk Of Kidney Problems Study Finds
This article was published more than 8 years ago. Some information may no longer be current.
High-potency statins Crestor, Lipitor and Zocor significantly reduce cholesterol levels.JB Reed/Bloomberg
Patients taking powerful cholesterol-lowering drugs may be putting their kidneys at risk, according to the results of a landmark Canadian study.
The researchers focused on “high-potency” statins Crestor, Lipitor and Zocor which are well known for their ability to significantly reduce cholesterol levels.
The study found that patients prescribed the high-strength statins faced a 34-per-cent higher risk of being hospitalized for acute kidney injury, compared to those taking the low-potency versions of these and other statin medications.
“Our findings put into question the common approach of using higher and higher doses to push cholesterol levels lower and lower,” said lead author Colin Dormuth, an epidemiologist and assistant professor at the University of British Columbia.
He noted that, for any individual patient, the risk remains relatively low. For instance, the study suggests one additional patient out of every 1,700 treated with high-potency statins for 120 days would end up in hospital with acute kidney injury a condition that used to be called acute renal failure.
In total, they reviewed the medical records of more than 2 million patients to reach their conclusions, which were published Tuesday on the website of the British Medical Journal.