Cardio-renal-metabolic risk reduction remains a major therapeutic priority in diabetic kidney disease (DKD), particularly in patients with concurrent dyslipidemia and elevated cardiovascular risk. A Bayesian network meta-analysis published in Frontiers in Endocrinology compared the effects of multiple lipid-lowering therapies on cardiovascular and renal outcomes in patients with DKD.

The analysis included 20 randomized controlled trials identified through searches of PubMed, Embase, Web of Science, and the Cochrane Library through May 10, 2025. The study evaluated the comparative effects of lipid-lowering agents on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), urine albumin-to-creatinine ratio (UACR), and cardiovascular event rates (CVER) in patients with hyperlipidemic DKD.

Findings

• Cerivastatin showed the greatest reduction in total cholesterol compared with other lipid-lowering therapies (Mean Difference [MD]: -94.03; 95% CI: -185.37 to -2.16).
• Simvastatin demonstrated the largest reduction in LDL-C levels (MD: -56.05; 95% CI: -101.64 to -11.66).
• Atorvastatin, rosuvastatin, and fenofibrate showed favorable effects on UACR, although the magnitude of renal benefit differed across agents.
• Atorvastatin was associated with the greatest reduction in cardiovascular event rates (MD: -3.19; 95% CI: -5.12 to -1.27).
• Fenofibrate also reduced cardiovascular event rates in hyperlipidemic DKD (MD: -1.44; 95% CI: -2.78 to -0.09).

The findings suggest that lipid-lowering therapies may offer differing cardiovascular and renal benefits in DKD, with atorvastatin and fenofibrate showing the most consistent cardiovascular risk reduction. Variable renal effects across therapies indicate that treatment selection may need to align with individual cardio-renal-metabolic risk profiles and therapeutic priorities.