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There are few published trial data on the effectiveness of lipid lowering in diabetic patients with impaired renal function. CARDS was a randomised placebo-controlled trial of atorvastatin 10 mg daily versus placebo in 2838 type 2 diabetic patients with no prior cardiovascular disease. Estimated glomerular filtration rate (eGFR) was assessed at baseline in 2744 patients with renal data using the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault equations. Cox proportional hazards models with adjustment for age and sex were used to establish whether baseline eGFR status (≥60 and <60 ml/min/1.73 m²) predicted risk of a major cardiovascular event (MCVE) and whether the efficacy of atorvastatin differed by baseline eGFR by testing for a treatment by eGFR interaction. At baseline, 967 patients (35%) had MDRD eGFR <60 mL/min/1.73 m². Compared to those with eGFR ≥60 mL/min/1.73 m², these patients were older, comprised more women and, adjusted for age and sex, did not have higher blood pressure, body mass index or lipid levels, but were more likely to be taking medications for hypertension and less likely to be smokers. During follow-up patients with eGFR <60 mL/min/1.73 m² were not at increased risk of MCVE (HR=0.99, p=0.96) or death (HR=1.25, p=0.28) compared to patients with eGFR ≥60 mL/min/1.73 m², although without adjustment their risk of death was higher (HR=1.50, p=0.04). These results were similar when the Cockcroft-Gault equation was used to estimate GFR. The treatment reduction in MCVE among all subjects with renal data at baseline was 41% (p<0.001). Among those with eGFR <60 mL/min/1.73 m², a similar treatment effect of atorvastatin was seen, with a 48% reduction in MCVE including a 42% reduction in acute coronary heart disease event, a 62% reduction in stroke and a 59% reduction in coronary revascularisation (p>0.25 for all tests of eGFR by treatment interaction). The absolute risk reduction in MCVE associated with atorvastatin over a median of 4 years was 3.8% in those with eGFR <60 mL/min/1.73 m² compared to 3.0% in those with eGFR ≥60 mL/min/1.73 m². These data show that atorvastatin 10 mg daily is equally efficacious in reducing coronary heart disease and stroke in diabetic patients with impaired renal function as in those with normal or near normal renal function. [ABSTRACT FROM AUTHOR]