Does receiving red yeast rice prescriptions (LipoCol Forte®) increase the risk of end-stage renal disease or not? A retrospective cohort study

BACKGROUND: The potential relationship between the consumption of red yeast rice (RYR) and the development of end-stage renal disease (ESRD) remains poorly understood. We aimed to evaluate the risk of ESRD in patients who used RYR. METHODS: Utilizing insurance claim records from 2010 to 2014, we performed a retrospective cohort analysis comparing 67,876 individuals using RYR against a control group of 90,836 lovastatin users (non-RYR group), with follow-up extending through 2019. The incidence of ESRD was analyzed using adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) within Cox proportional hazard models. RESULTS: During follow-up, the ESRD incidence was 0.9 per 1,000 person-years in RYR users, compared to 3.7 per 1,000 person-years in lovastatin users (HR 0.36, 95% CI 0.32-0.40). A dose-dependent reduction in ESRD risk was observed with increasing RYR prescriptions. Sensitivity analysis, excluding ESRD cases within the initial six months, confirmed a persistent association between RYR use and reduced ESRD risk (adjusted HR 0.72, 95% CI 0.64-0.81). CONCLUSION: RYR intake may be linked to a decreased likelihood of progressing to ESRD. Despite these promising results, factors such as medication adherence necessitate cautious interpretation. Further randomized controlled trials are required to validate these findings and clarify RYR's role in slowing kidney disease progression.