title: Meta-analysis on efficacy of statins for prevention of contrast-induced acute kidney injury in patients undergoing coronary angiography.
abstract: Contrast-induced acute kidney injury (CIAKI) is a leading cause of hospital-acquired acute kidney injury, and pretreatment with hydroxymethylglutaryl CoA reductase inhibitors (statins) have shown promise in prevention. A systematic review and meta-analysis was performed including randomized controlled trials of short-term high-dose statins (compared with either low-dose statin or placebo) for CIAKI prevention in patients undergoing coronary angiography. Study-specific odds ratios (ORs) were calculated, and between-study heterogeneity was assessed using the I(2) statistic. We used a random-effects model meta-analysis to pool the OR. Twelve RCTs, including 5,564 patients, were included. CIAKI occurred in 94 of 2,769 patients (3.4%) pretreated with high-dose statins and 213 of 2,795 patients (7.6%) in the low-dose or no-statin group (OR 0.43, 95% confidence interval [CI] 0.33 to 0.55, I(2) = 19%, p <0.001). Subgroup analysis showed that the occurrence of CIAKI did not differ in patients with diabetes (OR 0.60, 95% CI 0.43 to 0.85, I(2) = 0%, p = 0.004) or in patients with documented renal insufficiency (creatinine clearance <60 ml/min/m(2); OR 0.66, 95% CI 0.45 to 0.96, I(2) = 0%, p = 0.03). In conclusion, pretreatment with high-dose statins, compared with low-dose statins or placebo, in patients undergoing coronary angiography reduces the incidence of CIAKI. This benefit was seen irrespective of the presence of diabetes and chronic kidney disease. Future studies should identify optimum dosing protocols for each statin.
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania. Electronic address: acukaigwe@gmail.com.
authors.forename: Anene
authors.initials: A
authors.lastname: Ukaigwe
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania.
authors.forename: Paras
authors.initials: P
authors.lastname: Karmacharya
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania.
authors.forename: Maryam
authors.initials: M
authors.lastname: Mahmood
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Pathak
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania.
authors.forename: Madan Raj
authors.initials: MR
authors.lastname: Aryal
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania.
authors.forename: Leena
authors.initials: L
authors.lastname: Jalota
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Donato
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors