Usefulness of atorvastatin (80 mg) in prevention of contrast-induced nephropathy in patients with chronic renal disease.
We investigated the efficacy of short-term high-dose atorvastatin in decreasing the risk of contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) subjected to coronary angiography and/or angioplasty. CIN occurs in up to 15% of patients with pre-existing CKD and affects clinical outcome. The protective effect of statin therapy against CIN is still controversial. A prospective, single-center study of 304 patients with baseline estimated creatinine clearance <60 ml/min were randomized to receive atorvastatin 80 mg/day or placebo for 48 hours before and 48 hours after contrast medium administration. All patients received intravenous saline hydration and oral N-acetylcysteine 1,200 mg 2 times/day. Iso-osmolar contrast medium was used. CIN was defined as an absolute increase of serum creatinine > or = 0.5 mg/dl within 5 days after the procedure. CIN occurred in 31 patients (10%), 16 (11%) in the placebo group and 15 (10%) in the atorvastatin group (p = 0.86). Mean increase in creatinine was not significantly different in the 2 groups (0.59 + or - 0.17 in placebo group vs 0.72 + or - 0.26 mg/dl in atorvastatin group, p = 0.31). Persistent kidney injury, defined as 1-month increase from baseline creatinine value > or = 25%, was observed in 30% in the placebo group and in 31% in the atorvastatin group (p = 0.58). In conclusion, a short-term administration of high doses of atorvastatin before and after contrast exposure, in addition to standard intravenous hydration and oral N-acetylcysteine, does not decrease CIN occurrence in patients with pre-existing CKD.
Toso
Anna
A
Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy. anna.toso@libero.it
Maioli
Mauro
M
Leoncini
Mario
M
Gallopin
Michela
M
Tedeschi
Delio
D
Micheletti
Carlo
C
Manzone
Concetta
C
Amato
Marcello
M
Bellandi
Francesco
F
D000111:Acetylcysteine / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000139:chemically induced* / Q000150:complications; D012307:Risk Factors
D000924:Anticholesteremic Agents; D015415:Biomarkers; D003287:Contrast Media; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin; D003404:Creatinine; D000111:Acetylcysteine