Statin Initiation and Risk of Kidney Stone Progression

Background: Abnormal cholesterol metabolism has been identified as a risk factor for the formation of kidney stones. However, it remains uncertain whether intensive management of serum cholesterol levels, such as through the administration of statins, would ameliorate kidney stone progression, which are potentially associated with the prognosis of this population. Methods: We conducted a multicenter retrospective cohort study involving nephrolithiasis patients from China Renal Data System, utilizing a new-user design. Propensity score overlap weighting was employed to balance the baseline characteristics of participants. Weighted Cox proportional hazards models were utilized to compare the risk of kidney stone progression between patients who initiated statin therapy and those who did not. Additionally, we assessed the associations between serum cholesterol control levels and kidney stone progression among participants receiving statins. A series of subgroup analyses and sensitivity analyses were performed to evaluate the robustness of our findings. Results: Following a median follow-up period of 1.6 years, we observed the occurrence of 2240 kidney stone progression among a total of 53135 eligible patients. Compared to non-initiation of treatment, the initiation of statins was associated with a reduced risk of kidney stone progression (weighted HR: 0.83; 95% CI [0.74–0.94]), particularly in patients exhibiting higher baseline serum cholesterol levels. Furthermore, intensive management of serum cholesterol levels significantly diminished the risks of kidney stone progression. Similar findings were noted across most subgroups and sensitivity analyses, with the exception of those involving hyperuricemia. Conclusion: Our study indicated that the statin initiation significantly reduced the risk of kidney stone progression, particularly among those who achieve rigorous control of serum cholesterol levels. These findings highlight the essential role of lipid management in mitigating kidney stone progression.