Does atorvastatin influence serum C-reactive protein levels in patients on long-term hemodialysis?

The increase in serum C-reactive protein (CRP) levels is an independent determinant of cardiovascular events in long-term hemodialysis (HD) patients. Recently, statins have shown anti-inflammatory properties in addition to their lipid-lowering effect.

We designed a 6-month, prospective, randomized, controlled study to assess the safety and efficacy of atorvastatin in reducing serum CRP levels in long-term HD patients. Patients on HD therapy for at least 6 months, with autologous vascular access, were included. Patients presenting with illnesses and/or use of drugs that may affect CRP levels were excluded. After randomization, group A included 16 patients treated with atorvastatin (10 mg/d orally), and group B included 17 patients treated with placebo. Body mass index, Kt/V, normalized protein catabolic rate, mean blood pressure, and levels of hemoglobin, serum CRP, albumin, creatinine, lipids, and enzymes were recorded at baseline and after 6 months.

Qualitative/quantitative parameters were homogeneous between the groups at baseline. In group A, median serum CRP levels decreased from 9 mg/L (range, 5 to 22 mg/L) at baseline to 5 mg/L (range, 3 to 16 mg/L) after 6 months (P = 0.004). In group B, values were 8 mg/L (range, 4 to 14 mg/L) at baseline and 7 mg/L (range, 3 to 17 mg/L) after 6 months (P = 0.98). Serum CRP levels were lower in group A than group B at month-4 (5 mg/L; range, 3 to 11 mg/L versus 7 mg/L; range, 3 to 10 mg/L, respectively; P = 0.054) and month-6 evaluations (5 mg/L; range, 3 to 16 mg/L versus 7 mg/L; range, 3 to 17 mg/L, respectively; P = 0.060). After 6 months, only in group A was there a significant decrease in serum cholesterol levels (P = 0.041) and a significant increase in serum albumin levels (P = 0.004). Enzyme levels were stable during the study in both groups.

Administration of atorvastatin is safe in patients on long-term HD therapy and, in addition to its beneficial effects on lipid levels, induces a significant decrease in serum CRP levels, with a consequential increase in serum albumin levels.