Sumeet Gandhi1, Wassim Mosleh2, Husam Abdel-Qadir3, Michael E Farkouh4. 1. Division of Cardiology, McMaster University, Hamilton, Ontario, Canada. 2. Trinity College, Dublin, Ireland. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University of Toronto, Ontario, Canada. 4. Peter Munk Cardiac Centre, University of Toronto, Ontario, Canada; Heart and Stroke Richard Lewar Centre, University of Toronto, Ontario, Canada. Electronic address: michael.farkouh@uhn.ca.
Abstract
BACKGROUND: Contrast-induced acute kidney injury is an adverse outcome resulting from radiocontrast medium exposure during coronary angiography and percutaneous coronary intervention. METHODS: A systematic search was conducted to retrieve studies that investigated the impact of statin exposure before coronary angiography or percutaneous coronary intervention on the development of contrast-induced acute kidney injury. The primary outcome was the development of contrast-induced acute kidney injury. We separately analyzed statin/placebo comparisons and high-/low-dose statin comparisons. RESULTS: Fifteen randomized controlled trials met inclusion criteria: 11 studies with statin-naïve subjects, 2 studies with chronic statin users, and 2 studies with unspecified prior statin exposure. Statin exposure reduced the risk of contrast-induced acute kidney injury relative to placebo (relative risk [RR] 0.63, P = .01) with a nonsignificant reduction in the need for hemodialysis (RR 0.25, P = .08). This benefit was also observed in high-dose versus low-dose statin trials (RR 0.46, P = .004), in statin-naïve patients (RR 0.53, P <.0001), and with all studied statins. Higher statin exposure reduced contrast-induced acute kidney injury in patients with acute coronary syndromes compared with placebo or low-dose statins (RR 0.49, P <.00001), with no significant benefit among patients undergoing elective procedures (RR 0.86, P = .50). Subgroup analyses confirmed the benefit of statins in patients with diabetes, chronic kidney disease, congestive heart failure, and those receiving >140 mL of contrast dye. CONCLUSION: Statin therapy is effective at reducing the risk of contrast-induced acute kidney injury. It should thus be considered, at least on a short-term basis, for patients at increased risk of this complication.
BACKGROUND: Contrast-induced acute kidney injury is an adverse outcome resulting from radiocontrast medium exposure during coronary angiography and percutaneous coronary intervention. METHODS: A systematic search was conducted to retrieve studies that investigated the impact of statin exposure before coronary angiography or percutaneous coronary intervention on the development of contrast-induced acute kidney injury. The primary outcome was the development of contrast-induced acute kidney injury. We separately analyzed statin/placebo comparisons and high-/low-dose statin comparisons. RESULTS: Fifteen randomized controlled trials met inclusion criteria: 11 studies with statin-naïve subjects, 2 studies with chronic statin users, and 2 studies with unspecified prior statin exposure. Statin exposure reduced the risk of contrast-induced acute kidney injury relative to placebo (relative risk [RR] 0.63, P = .01) with a nonsignificant reduction in the need for hemodialysis (RR 0.25, P = .08). This benefit was also observed in high-dose versus low-dose statin trials (RR 0.46, P = .004), in statin-naïve patients (RR 0.53, P <.0001), and with all studied statins. Higher statin exposure reduced contrast-induced acute kidney injury in patients with acute coronary syndromes compared with placebo or low-dose statins (RR 0.49, P <.00001), with no significant benefit among patients undergoing elective procedures (RR 0.86, P = .50). Subgroup analyses confirmed the benefit of statins in patients with diabetes, chronic kidney disease, congestive heart failure, and those receiving >140 mL of contrast dye. CONCLUSION: Statin therapy is effective at reducing the risk of contrast-induced acute kidney injury. It should thus be considered, at least on a short-term basis, for patients at increased risk of this complication.
Authors: Edwin A Takahashi; David F Kallmes; Chad J Fleming; Robert J McDonald; Michael A McKusick; Haraldur Bjarnason; William S Harmsen; Sanjay Misra Journal: J Vasc Interv Radiol Date: 2017-09-22 Impact factor: 3.464
Authors: Dadi Helgason; Thorir E Long; Solveig Helgadottir; Runolfur Palsson; Gisli H Sigurdsson; Tomas Gudbjartsson; Olafur S Indridason; Ingibjorg J Gudmundsdottir; Martin I Sigurdsson Journal: J Nephrol Date: 2018-09-05 Impact factor: 3.902