China: A large real-world study from Hong Kong suggests that rosuvastatin and atorvastatin have comparable effects on progression to end-stage kidney disease (ESKD) in Chinese patients with diabetes. While rosuvastatin may offer modest cardiovascular advantages, it comes at the cost of a higher risk of albuminuria.The findings are from an emulated target trial published in eClinicalMedicine by Yanting Huang from the Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, and colleagues.Statins are a mainstay of lipid-lowering therapy in people with diabetes and chronic kidney disease (CKD). However, concerns have been raised about rosuvastatin after studies in Western populations linked it to a greater risk of kidney impairment compared with atorvastatin. Whether these observations apply to East Asian populations has remained uncertain, particularly because East Asians are known to have higher systemic exposure to rosuvastatin due to ethnic differences in drug metabolism.To address this gap, the researchers analysed data from 106,677 adults with type 1 or type 2 diabetes treated in Hong Kong between 2002 and 2019. Using a propensity-score overlap-weighted design to emulate a target trial, they compared 92,940 new users of rosuvastatin with 13,737 new users of atorvastatin across different CKD stages.Patients with missing kidney function data, baseline ESKD, or age below 18 years were excluded. The primary outcome was incident ESKD, defined by dialysis, kidney replacement therapy, or sustained estimated glomerular filtration rate (eGFR) below 15 ml/min/1.73 m². Secondary outcomes included major adverse cardiovascular events (MACE), all-cause mortality, and new-onset albuminuria. The study revealed the following findings:At baseline, nearly three-quarters of participants had preserved or mildly reduced kidney function (CKD stages G1–G2), around one-fifth had stage G3 disease, and a smaller proportion had advanced CKD (G4).Over a median follow-up of 2.33 years, 3.45% of patients progressed to end-stage kidney disease, 5.78% experienced major adverse cardiovascular events, and just over 10% died.When statin use was assessed as a fixed baseline exposure, rosuvastatin was associated with similar risks of end-stage kidney disease, cardiovascular events, and all-cause mortality compared with atorvastatin.Analyses incorporating time-varying statin exposure showed that rosuvastatin was linked to a lower risk of major adverse cardiovascular events and all-cause mortality.Across analyses, rosuvastatin was consistently associated with a higher, dose-dependent risk of new-onset albuminuria compared with atorvastatin.According to the authors, these results suggest that in East Asian patients with diabetes, rosuvastatin does not increase the risk of kidney failure compared with atorvastatin and may confer additional cardiovascular benefits. At the same time, the higher likelihood of albuminuria highlights the need for careful renal monitoring, particularly at higher doses.The study has limitations, including a relatively short follow-up period and the observational nature of the analysis, which leaves room for residual confounding. Nevertheless, the findings provide important region-specific evidence to guide statin choice.The researchers conclude that treatment decisions should be individualised, balancing cardiovascular protection against potential renal effects, and call for longer-term studies to better define the renal safety of high-intensity rosuvastatin in patients with diabetes and CKD.Reference: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370%2825%2900646-7/fulltext