TNT: Sub-analysis Evaluating Renal Function

28 Oct, 10

TNT: Sub-analysis Evaluating Renal Function

Introduction

Intensive lipid lowering with 80 mg atorvastatin yields significantly greater benefits on renal function as compared to 10 mg atorvastatin in stable CHD: Analysis of Treating to New Targets (TNT) study

Aim

To compare the effect on renal function with 80 mg atorvastatin vs. 10 mg atorvastatin in patients with stable coronary heart disease (CHD)

Methods

Analysis of TNT study

Patients

Stable CHD with complete data on renal function parameters (N=9656)

Study Groups

Atorvastatin 80 mg (N=4827) vs. Atorvastatin 10 mg (N=4829)

Median Follow-up Period

5 years

Efficacy Outcome Measure

Estimated glomerular filtration rate (eGFR) at baseline and end of follow-up

Results

There was a progressive increase in eGFR in both treatment groups; however, the increase in eGFR was significantly greater in patients receiving 80 mg atorvastatin (8.3%) vs. those receiving 10 mg atorvastatin (5.6%) [Figure 1]

Figure 1. Changes in eGFR with atorvastatin 80 mg and 10 mg

CKD patients had a greater increase in eGFR from baseline and patients with low LDL had significantly greater improvement in eGFR
In the group receiving 80 mg atorvastatin, significantly lesser patients had worsening of renal function and significantly greater patients had improvement in renal function (Figure 2)

Figure 2. Proportion of participants with decline or improvement from baseline eGFR at the end of treatment

Significantly fewer CKD patients experienced a decline in eGFR of >25% in the 80 mg group (3.4%) vs. 10 mg group (5.3%)

Safety

There were similar incidences of adverse events in both the treatment groups, with no reports of hematuria or proteinuria

Conclusion

In addition to improved lipid control and further reductions in major CV events, benefits of aggressive atorvastatin therapy extend to significant improvements in renal function over that achieved with lower dosage atorvastatin therapy

Clinical Implications

Lowering LDL cholesterol levels to well below 100 mg/dl with high-dosage atorvastatin seems to maximize renal benefits in high-risk patients with CHD and should not be contraindicated in moderate CKD.

Clin J Am Soc Nephrol 2007 Oct 17; [Epub ahead of print]