title: Association between preoperative statin use and acute kidney injury biomarkers in cardiac surgical procedures.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a serious complication of cardiac operations for which there remains no specific therapy. Animal data and several observational studies suggest that statins prevent AKI, but the results are not conclusive, and many studies are retrospective in nature.
  
  
  METHODS
  We conducted a multicenter prospective cohort study of 625 adult patients undergoing elective cardiac operations. All patients were taking statins and were grouped according to whether statins were continued or held in the 24 hours before operation. The primary outcome was AKI as defined by a doubling of serum creatinine or dialysis. The secondary outcome was the peak level of several kidney injury biomarkers. The results were adjusted for demographic and clinical factors.
  
  
  RESULTS
  Continuing (vs holding) a statin before operation was not associated with a lower risk of AKI, as defined by a doubling of serum creatinine or dialysis (adjusted relative risk [RR] 1.09; 95% confidence interval [CI] 0.44, 2.70). However, continuing a statin was associated with a lower risk of elevation of the following AKI biomarkers: urine interleukin-18, urine neutrophil gelatinase-associated lipocalin, urine kidney injury molecule-1, and plasma neutrophil gelatinase-associated lipocalin (adjusted RR 0.34; 95% CI 0.18, 0.62), (adjusted RR 0.41; 95% CI 0.22, 0.76), (adjusted RR 0.37; 95% CI 0.20, 0.76), (adjusted RR 0.62; 95% CI 0.39, 0.98), respectively.
  
  
  CONCLUSIONS
  Statins may prevent kidney injury after cardiac operations, as evidenced by lower levels of kidney injury biomarkers.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Amber O
authors.initials: AO
authors.lastname: Molnar
authors.affiliation: Section of Nephrology, Yale University School of Medicine, Veterans Affairs CT Healthcare System, and the Program of Applied Translational Research, New Haven, Connecticut; Department of Medicine, Veterans Affairs Medical Center, West Haven, Connecticut. Electronic address: chirag.parikh@yale.edu.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.affiliation: Section of Nephrology, Yale University School of Medicine, Veterans Affairs CT Healthcare System, and the Program of Applied Translational Research, New Haven, Connecticut.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.affiliation: Section of Nephrology, Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, Illinois.
authors.forename: Jay L
authors.initials: JL
authors.lastname: Koyner
authors.affiliation: Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: Division of Cardiac Surgery, Western University, London, Ontario, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Lee Myers
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000209:Acute-Phase Proteins / Q000652:urine; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D020382:Interleukin-18 / Q000652:urine; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine; D008875:Middle Aged; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine; D011991:Receptors, Virus
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus
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