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Short-term safety and efficacy of escalating doses of atorvastatin for dyslipidemia in children with predialysis chronic kidney disease stage 2–5

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Abstract

Background

Dyslipidemia is a potentially modifiable risk factor in patients with chronic kidney disease (CKD). Information on the safety and efficacy of statins in pediatric CKD is limited.

Methods

Patients with CKD stage 2–5 and aged 5–18 years with low-density lipoprotein cholesterol (LDL-C) > 130 mg/dL and/or non-high-density lipoprotein cholesterol (non-HDL-C) > 145 mg/dL were enrolled from September 2019 to February 2021. All patients were administered atorvastatin 10 mg/day, which was escalated to 20 mg/day if LDL-C remained > 100 mg/dL and/or non-HDL-C > 120 mg/dL at 12 weeks. Proportion of patients achieving target lipid levels (LDL-C ≤ 100 mg/dL and non-HDL-C ≤ 120 mg/dL) and adverse events were assessed at 24 weeks.

Results

Of 31 patients enrolled, target lipid levels were achieved in 45.2% (95% CI 27.8–63.7%) at 24 weeks; 22 patients required dose escalation to 20 mg at 12 weeks. There was no difference in median lipid level reduction with 10 (n = 9) versus 20 mg/day (n = 22, P = 0.3). Higher baseline LDL-C (OR 1.06, 95% CI 1.00–1.11) and older age (OR 36.5, 95% CI 2.57–519.14) were independent predictors of failure to achieve target lipid levels with 10 mg/day atorvastatin. None had persistent rise in AST/ALT > 3 times upper normal limit (UNL) or CPK > 10 times UNL. No differences were noted in adverse events due to atorvastatin 10 or 20 mg/day.

Conclusion

Atorvastatin (10–20 mg/day) administered for 24 weeks was safe and effectively reduced LDL-C and non-HDL-C in children with CKD stages 2–5. Patients with higher baseline LDL-C required higher doses to achieve the target.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Punitha Lakxmi Ramesh, Priyanka Khandelwal, Aditi Sinha, Arvind Bagga & Pankaj Hari

  2. Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India

    R. Lakshmy

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  1. Punitha Lakxmi Ramesh
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  2. Priyanka Khandelwal
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Correspondence to Pankaj Hari.

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Ramesh, P.L., Khandelwal, P., Lakshmy, R. et al. Short-term safety and efficacy of escalating doses of atorvastatin for dyslipidemia in children with predialysis chronic kidney disease stage 2–5. Pediatr Nephrol 38, 2763–2770 (2023). https://doi.org/10.1007/s00467-023-05887-0

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