Statins and contrast-induced acute kidney injury with coronary angiography.
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.


CONCLUSIONS
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.
Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
Sumeet
S
Gandhi
Trinity College, Dublin, Ireland.
Wassim
W
Mosleh
Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University of Toronto, Ontario, Canada.
Husam
H
Abdel-Qadir
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.
Michael E
ME
Farkouh
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D016206:Databases, Bibliographic; D048909:Diabetes Complications; D006333:Heart Failure / Q000150:complications; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D065840:Protective Factors; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors
D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
CIN; PCI; angiogram; atorvastatin; contrast-induced acute kidney injury; contrast-induced nephropathy; coronary angiography; percutaneous coronary intervention; rosuvastatin; simvastatin; statins