title: Do statin medications impact renal functional or oncologic outcomes for robot-assisted partial nephrectomy?
abstract: OBJECTIVE
  To evaluate if statin medications (3-hydroxyl-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitors) improve either oncologic or renal functional outcomes for patients undergoing robot-assisted partial nephrectomy (RPN).
  
  
  METHODS
  Patients undergoing RPN between March 2008 and October 2013 were evaluated from a prospectively maintained database for statin usage. The rate of perioperative acute kidney injury (AKI), as defined according to the RIFLE criteria, and the progression of chronic kidney disease (CKD) were compared between users and nonusers. Oncologic outcomes and rate of progression were compared between users and nonusers.
  
  
  RESULTS
  One hundred four (31%) of 339 patients were on statin therapy preoperatively and continued this medication peri- and postoperatively. Statin patients were older and had higher rates of comorbidities, including coronary artery disease, diabetes, and hypertension (p<0.0001 for all).The rate of AKI in the statin (16%) and nonstatin patients (14%) (p=0.60) and CKD progression based on Kaplan-Meier estimates (p=0.57) were similar between both the groups. Subgroup analysis of the 271 (80%) patients with hilar clamping also had similar rates of AKI, in statin users 10% vs 12% in nonusers (p=0.50). Multivariate analysis of factors affecting CKD progression confirmed these findings. Oncologic progression was not affected by statin therapy (p=0.90).
  
  
  CONCLUSIONS
  Statin medications do not appear to influence perioperative renal function following RPN, in either clamped or unclamped procedures. Continuation of these medications may be continued perioperatively, but any effect on renal functional or oncologic outcomes was not elucidated in this study.
authors.affiliation: Department of Urology, Wake Forest Baptist Health , Winston-Salem, North Carolina.
authors.forename: L Spencer
authors.initials: LS
authors.lastname: Krane
authors.forename: Jason Michael
authors.initials: JM
authors.lastname: Sandberg
authors.forename: James T
authors.initials: JT
authors.lastname: Rague
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D003250:Constriction; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D011292:Premedication; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors