The effect of atorvastatin on inflammatory markers, lipid profile, and renal function in kidney diseases: a systematic review and meta-analysis of randomized controlled trials

• Atorvastatin dramatically raises HDL cholesterol while decreasing LDL cholesterol and total cholesterol • The oxidative stress marker MDA decreased significantly after atorvastatin treatment. • CRP decreases were only substantial in CKD patients treated with low-dose atorvastatin. • Subgroup studies revealed that monotherapy resulted in superior lipid improvements and longer treatment durations. • Atorvastatin was well tolerated, with no major safety issues noted across the studies. Chronic and acute kidney disorders (CKD, AKI) afflict millions globally, leading to increased morbidity and death, especially from cardiovascular consequences. Atorvastatin, a popular statin, offers lipid-lowering, anti-inflammatory, and antioxidant qualities that may assist kidney disease patients in terms of renal and cardiovascular health. This meta-analysis assesses atorvastatin's effectiveness and safety in terms of lipid profiles, inflammatory biomarkers, and renal function in patients with kidney disorders. A thorough search of Scopus, Cochrane, Embase, Web of Science, Google Scholar, and PubMed until January 2025 revealed randomized controlled trials (RCTs) evaluating atorvastatin in CKD, diabetic nephropathy, hemodialysis, and other renal diseases. The outcomes included lipid parameters (HDL, LDL, total cholesterol, triglycerides), inflammatory markers (hsCRP, IL-6, MDA), and renal function indices. Random-effects models were used to pool weighted mean differences (WMDs) and 95% confidence intervals (CIs). Subgroup analyses were performed based on dosage, duration, disease type, and treatment type. The risk of bias and publication bias was evaluated. Twelve RCTs with 18 trials and sample sizes ranging from 21 to 156 participants were included. As expected, atorvastatin significantly improved HDL cholesterol (WMD: 2.74 mg/dL; 95% CI: 0.57 to 4.91; p<0.001) while dramatically decreasing LDL cholesterol (WMD: -13.09 mg/dL; 95% CI: -21.17 to -5.00; p<0.001) and total cholesterol (WMD: -15.28 mg/dL; 95% CI: -24.58 to -5.98; p<0.001) at lower dosages of ≤10 mg/day and longer treatment periods. More notably, it also reduced MDA (WMD: -2.80; 95% CI: -3.62 to -1.97; p < 0.001) and showed anti-inflammatory effects by reducing hsCRP in CKD patients receiving a ≤10 mg/day dosage. Atorvastatin medication improves lipid profiles and lowers oxidative stress indicators in renal disease patients, with some indications of decreased inflammation in select subgroups, indicating a possible function as an adjuvant treatment to reduce cardiovascular risk. Future large-scale RCTs are needed to determine the appropriate dose and long-term kidney results.