title: Preoperative statins and acute kidney injury after cardiac surgery: utilization of a consensus definition of acute kidney injury.
abstract: BACKGROUND
  Previous trials investigating preoperative statin use for prevention of acute kidney injury following cardiovascular surgery were limited to patients undergoing a specific procedure and many used nonconsensus definitions of acute kidney injury.
  
  
  OBJECTIVE
  To use a consensus definition of acute kidney injury for evaluating the association of preoperative statin use with the development of acute kidney injury following cardiac surgery utilizing cardiopulmonary bypass.
  
  
  METHODS
  We retrospectively evaluated a cohort of 667 patients ≥18 years who underwent any cardiac surgery on cardiopulmonary bypass between April 2007 and May 2009 at Mercy Hospital in Scranton, PA. Patients were excluded if they were receiving preoperative renal replacement therapy, had stage 5 chronic kidney disease, or did not have a postoperative serum creatinine level assessed. The primary outcome was the odds of developing acute kidney injury given the use of preoperative statins. Acute kidney injury was defined based on the Acute Kidney Injury Network criteria as either an absolute increase in serum creatinine of ≥0.3 mg/dL or 1.5 times baseline, or the need for postoperative renal replacement therapy.
  
  
  RESULTS
  The final analysis included 563 patients; 356 were receiving preoperative statins. The incidence of acute kidney injury was 35.1% in the statin group and 26.1% in the non-statin group. On univariate analysis statins were associated with an increase in the odds of acute kidney injury (OR 1.53; 95% CI 1.05 to 2.24). Multivariate logistic regression did not demonstrate an association of statins with acute kidney injury (OR 1.36; 95% CI 0.904 to 2.05). Repeating the analysis using 312 propensity score-matched patients also showed no association of statins with acute kidney injury (OR 1.17; 95% CI 0.715 to 1.93).
  
  
  CONCLUSIONS
  Our findings do not support the hypothesis that preoperative statin use is associated with a decrease in the incidence of acute kidney injury following cardiac surgery utilizing cardiopulmonary bypass.
authors.affiliation: Department of Pharmacy Practice, Wilkes University, Wilkes-Barre, PA, USA. scott.bolesta@wilkes.edu
authors.forename: Scott
authors.initials: S
authors.lastname: Bolesta
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: Uhrin
authors.forename: John R
authors.initials: JR
authors.lastname: Guzek
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors