Y Zhou1, W J Yuan, N Zhu, L Wang. 1. Department of Nephrology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Abstract
BACKGROUND: There have been conflicting reports on the use of statins for prevention of contrast-induced nephropathy (CIN). The aim of this study was to assess the effectiveness of short-term (2 - 7 days), high-dose (80 mg/d) statins in the prevention of CIN. STUDY DESIGN, SETTING AND PARTICIPANTS: Randomized controlled trials assessing the preventive effect of short-term, highdose statins on CIN (published from 1966 to 2010) were searched. QUALITY IMPROVEMENT PLAN: Quality of the trials was evaluated with the assessing risk of bias in studies included in the Cochrane reviews. OUTCOMES: CIN is the primary endpoint of the study. MEASUREMENTS: Meta-regression and a fixed-effects model were used for analyses. RESULTS: Five trials with a total of 1,009 patients were identified, with the overall effect of statins showing benefit for preventing CIN (relative risk (RR) = 0.53, 0.32 - 0.87). Meta-regression showed the existence of minor heterogeneity (I² = 19%) could be largely accounted for by baseline serum creatinine. Two studies conducted in patients with CKD Stage ≥ 3 did not reveal a statistically significant difference in CIN incidence between the statin and placebo groups (6.5% vs. 7.2%) (RR = 0.89, 0.46 - 1.73), without evidence of heterogeneity (I² = 0%, p = 0.79). The remaining three studies conducted in patients with CKD Stage > 3 revealed a significantly lower CIN incidence in the statin groups (3.6% vs. 11.9%) (RR = 0.28, 0.13 - 0.62), without evidence of heterogeneity (I2 = 0%, p = 0.87). CONCLUSIONS: The overall effect of shortterm, high-dose statin treatment seems to be helpful for prevention of CIN. However, the subgroup analysis shows statin benefit only in patients with CKD Stage > 3, but not in patients with CKD Stage ≤ 3. LIMITATIONS: The relative low quality of the individual studies and limited studies means that only a limited conclusion on the use of statin for prevention of CIN was possible.
BACKGROUND: There have been conflicting reports on the use of statins for prevention of contrast-induced nephropathy (CIN). The aim of this study was to assess the effectiveness of short-term (2 - 7 days), high-dose (80 mg/d) statins in the prevention of CIN. STUDY DESIGN, SETTING AND PARTICIPANTS: Randomized controlled trials assessing the preventive effect of short-term, highdose statins on CIN (published from 1966 to 2010) were searched. QUALITY IMPROVEMENT PLAN: Quality of the trials was evaluated with the assessing risk of bias in studies included in the Cochrane reviews. OUTCOMES: CIN is the primary endpoint of the study. MEASUREMENTS: Meta-regression and a fixed-effects model were used for analyses. RESULTS: Five trials with a total of 1,009 patients were identified, with the overall effect of statins showing benefit for preventing CIN (relative risk (RR) = 0.53, 0.32 - 0.87). Meta-regression showed the existence of minor heterogeneity (I² = 19%) could be largely accounted for by baseline serum creatinine. Two studies conducted in patients with CKD Stage ≥ 3 did not reveal a statistically significant difference in CIN incidence between the statin and placebo groups (6.5% vs. 7.2%) (RR = 0.89, 0.46 - 1.73), without evidence of heterogeneity (I² = 0%, p = 0.79). The remaining three studies conducted in patients with CKD Stage > 3 revealed a significantly lower CIN incidence in the statin groups (3.6% vs. 11.9%) (RR = 0.28, 0.13 - 0.62), without evidence of heterogeneity (I2 = 0%, p = 0.87). CONCLUSIONS: The overall effect of shortterm, high-dose statin treatment seems to be helpful for prevention of CIN. However, the subgroup analysis shows statin benefit only in patients with CKD Stage > 3, but not in patients with CKD Stage ≤ 3. LIMITATIONS: The relative low quality of the individual studies and limited studies means that only a limited conclusion on the use of statin for prevention of CIN was possible.