{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:06:07Z","timestamp":1780031167255,"version":"3.53.1"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In diabetic kidney disease (DKD), dyslipidemia accelerates renal decline and heart failure risk, making Cardio-Renal-Metabolic (CRM) risk reduction critical. The bidirectional relationship between cardiac and renal dysfunction further highlights the necessity of lipid-lowering therapy as a common intervention pathway; however, its comparative efficacy remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the Cardio-Renal-Metabolic (CRM) outcomes of various lipid-lowering agents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Embase, Web of Science, and Cochrane Library for Randomized Controlled Trials (RCTs) up to May 10, 2025; a Bayesian network meta-analysis compared their effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 20 RCTs, Cerivastatin best reduced Total Cholesterol (TC) (Mean Difference (MD): -94.03, 95% CI: -185.37 to -2.16), while Simvastatin best lowered Low-Density Lipoprotein Cholesterol (LDL-C) (MD: -56.05, 95% CI: -101.64 to -11.66). For cardiorenal outcomes, Atorvastatin, Rosuvastatin, and Fenofibrate potentially improved Urine Albumin-to-Creatinine Ratio (UACR). Atorvastatin (MD: -3.19, 95% CI: -5.12 to -1.27) and Fenofibrate (MD: -1.44, 95% CI: -2.78 to -0.09) most robustly reduced cardiovascular event rates (CVER) in hyperlipidemic DKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lipid-lowering agents have divergent effects; Atorvastatin and Fenofibrate best reduce CVER despite variable renal effects, supporting a phenotype-driven CRM strategy prioritizing residual cardiovascular risk reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/<\/jats:ext-link>\n                      , identifier CRD420251049719.\n                    <\/jats:p>\n                  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Heilongjiang Academy of Chinese Medicine Sciences","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimei","family":"Hua","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Medicine, Heilongjiang Academy of Chinese Medicine Sciences","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"An","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Medicine, Heilongjiang Academy of Chinese Medicine Sciences","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifan","family":"Wang","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Medicine, Heilongjiang Academy of Chinese Medicine Sciences","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Li","sequence":"additional","affiliation":[{"name":"Beijing Key Lab for Immune-Mediated 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