Atorvastatin (CKD Cardiovascular Risk)

How it works

It competitively inhibits HMG-CoA reductase, the rate-limiting enzyme of hepatic cholesterol synthesis, upregulating LDL receptors and lowering circulating LDL cholesterol.

Prescribing in practice

• Atorvastatin is preferred in CKD because it is cleared hepatically and needs no renal dose adjustment, unlike statins requiring reduction at low eGFR.
• CKD raises myopathy risk, so review concomitant drugs and advise reporting unexplained muscle pain, tenderness or weakness.
• Avoid co-prescribing with potent CYP3A4 inhibitors and use caution with drugs that increase statin exposure, such as certain calcineurin inhibitors.

Monitoring

Check a lipid profile and liver transaminases at baseline and as indicated, and measure creatine kinase if muscle symptoms occur.

Counselling the patient

• Take it at any consistent time of day; it works while you sleep.
• Report unexplained muscle pain, weakness or dark urine.
• Avoid large quantities of grapefruit juice.

Evidence & guidelines

Statin use for cardiovascular prevention in CKD is supported by the SHARP trial and NICE lipid-modification and CKD guidance.