Preoperative statin use and postoperative acute kidney injury.
BACKGROUND
Acute kidney injury is a frequent postoperative complication that confers increased mortality, morbidity, and costs. The purpose of this study was to evaluate whether preoperative statin use is associated with a decreased risk of postoperative acute kidney injury.


METHODS
We assembled a retrospective cohort of 98,939 patients who underwent a major open abdominal, cardiac, thoracic, or vascular procedure between 2000 and 2010. Statin users were pair-matched to nonusers on the basis of surgery type, baseline kidney function, days from admission until surgery, and propensity score based on demographics, comorbid conditions, and concomitant medications. Acute kidney injury was defined based on changes in serum creatinine measurements applying Acute Kidney Injury Network and Risk-Injury-Failure staging systems, and on the need for renal replacement therapy. Associations between statin use and acute kidney injury were estimated by conditional logistic regression.


RESULTS
Across various acute kidney injury definitions, statin use was consistently associated with a decreased risk: adjusted odds ratios (95% confidence intervals) varied from 0.74 (0.58-0.95) to 0.80 (0.71-0.90). Associations were similar among diabetics and nondiabetics, and across strata of baseline kidney function. The protective association of statins was most pronounced among patients undergoing vascular surgery and least among patients undergoing cardiac surgery.


CONCLUSIONS
Preoperative statin use is associated with a decreased risk of postoperative acute kidney injury. Future randomized clinical trials are needed to determine causality.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA. sbrunelli@partners.org
Steven M
SM
Brunelli
Sushrut S
SS
Waikar
Brian T
BT
Bateman
Tara I
TI
Chang
Joyce
J
Lii
Amit X
AX
Garg
Wolfgang C
WC
Winkelmayer
Niteesh K
NK
Choudhry
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000517:prevention & control*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D057234:Preoperative Period; D057216:Propensity Score; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors