Sir, 

The recent conclusion of SATURN (Study of Coronary Atheroma by InTravascular Ultrasound: Effect of 
Rosuvastatin versus AtorvastatiN) study,1 demonstrated that maximal suggested doses of both atorvastatin 
and rosuvastatin ameliorate atherosclerosis to a similar extent by facilitating the regression of percent 
atheroma volume. Both statins, however, caused renal proteinurea, albeit to different extents. The published 
results of the study ephemerally state that “proteinuria was commoner in the rosuvastatin group than in the 
atrovastatin group (3.8% versus 1.7%)”. Further, the treatment group pertaining to atrorvastatin had higher 
number of diabetics compared to the group on rosuvastatin (16.8% versus 13.8%). Diabetes augments kidney 
failure,2,3 accounting for nearly 44% of new cases in the United States, therefore it is plausible the atorvastatin 
treatment group had more patients with renal dysfunction than the rosuvastatin treatment group whereby 
the actual reported percentage of patients with proteinuria on rosuvastatin might not reflect the true value. 

The median age of the participants in SATURN-trial is ~57 years. An individual of 57 years has an average 
glomerular filtration rate (GFR) of 93 ml/min/1.73m2 versus 116 ml/min/1.73m2 observed in individuals 
20–29 years of age, indicating a decline in renal function with advancement with age. The intriguing issue 
of pivotal importance remaining unanswered is “Which statin should preferably be administered in patients 
who are elderly with declining renal function/chronic kidney disease (CKD) patients/ patients with diabetic 
proteinuria?” 

Currently, with contradicting results from several trials, a conclusive answer to the above is unavailable. 
As a case in point, atorvastatin exhibited reno-protective effects in the Treating to New Targets (TNT) study, 
but decreased estimated (e)-GFR in PLANET-I and CARDS trials.4,5 Similarly, rosuvastatin exhibited reno-
protective effects in mouse-model experiments, but in PLANET-I it exhibited reno-deleterious effects as it 
significantly decreased e-GFR.6 The results of the SHARP trial,7 show promise where simvastin plus

SQU Med J, May 2012, Vol. 12, Iss. 2, pp. 245-246, Epub. 9th Apr 2012  
Submitted 12th Feb 12
Accepted 22nd Feb 12

نوعية أدوية الستاتني املفضلة لعالج اضطراب 
اْسِتْقاَلِب الشَّْحِميَّات

 عند مرضى اخللل الوظيفي الكلوي
)SATURN( مالحظات من الدراسة العاملية

Statin of Preference to Treat Dyslipidaemia in 
Patients with Renal Dysfunction

Cues from (SATURN)

LETTER TO EDITOR



Statin of Preference to Treat Dyslipidaemia in Patients with Renal Dysfunction 
Cues from SATURN

246 | SQU Medical Journal, May 2012, Volume 12, Issue 2

ezetimibe could be prescribed for patients with renal dysfunction, without plausible detrimental effects 
on renal health, although the trial lacked a longer follow-up period.8 Future head-to-head trials with different 
statins or a statins plus non-statin-cholesterol lowering drug combination, conducted in a patient population 
with CKD and with a suitable follow up period, are essential to answer the question posed above. In the 
meantime, clinicians will have to choose the statin appropriate to the need of the patient.

Khalid Al-Waili,1 Tamima Al-Dughaishi,2 Khalid Al-Rasadi,1 Riad Bayoumi,3 *Yajnavalka Banerjee3

Departments of 1Biochemistry, 2Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman; 3Department of 
Biochemistry, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman

*Corresponding Author e-mail: yaj.banerjee@gmail.com

Reference
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on progression of coronary disease. N Engl J Med 2011; 365:2078–87.

2. Al-Lamki L. Acute coronary syndrome, diabetes and hypertension: Oman must pay more attention to chronic non-
communicable diseases. Sultan Qaboos Univ Med J 2011; 11:318–21.

3. Panduranga P, Sulaiman K, Al-Zakwani I. Acute coronary syndrome in Oman: results from the Gulf Registry of 
Acute Coronary Events. Sultan Qaboos Univ Med J 2011; 11:338–42.

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events in patients undergoing hemodialysis. N Engl J Med 2009; 360:1395–407.

7. Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, et al. The effects of lowering LDL cholesterol 
with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a 
randomised placebo-controlled trial. Lancet 2011; 377:2181–92.

8. Al-Rasadi K, Banerjee Y. Benefits of lowering cholesterol in chronic kidney disease. Lancet 2011; 378:1376–7.