Do statins prevent acute kidney injury?

Philips, Barbara J.; MacPhee, Iain

doi:10.1517/14740338.2015.1085504

Cited by 7 publications

(3 citation statements)

References 98 publications

(87 reference statements)

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“…Statins have been shown to have anti-inflammatory effects by reducing the levels of inflammatory cytokines as well as circulating microparticles, which are involved in inflammatory cell activation (35). However, whether or not the use of statins preoperatively can decrease the incidence of CSA-AKI remains controversial (36-38); further studies are therefore needed.…”

Section: Discussionmentioning

confidence: 99%

Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study

Xie

Wan

et al. 2017

Intern. Med.

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Objective To evaluate the incidence, risk, or protective factors of acute kidney injury (AKI) in patients after cardiac surgery based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Methods A retrospective analysis of 2,575 patients undergoing their first documented cardiac surgery with cardiopulmonary bypass (CPB) was conducted. Perioperative variables were collected and analyzed. Univariate and multiple logistic regression models were used for determining the association between the development of AKI and risk factors. Multiple Cox-proportional hazards modeling was performed to evaluate the impact of AKI on the mortality in the intensive care unit and hospital length of stay. Results Of 2,575 patients, 931 (36%) developed AKI. A total of 30 (1.2%) patients required renal replacement therapy. In the multivariate analysis, mechanical ventilation duration (OR1.446, 95% CI 1.195-1.749, p<0.001), CPB duration of ≥110 min (OR 1.314, 95% CI 1.072-1.611, p=0.009), erythrocytes transfusion (OR 1.078, 95% CI 1.050-1.106, p<0.001), and postoperative body temperature greater than 38℃ within 3 days (OR 1.234, 95% CI 1.018-1.496, p=0.032) were independent risk factors for CSA-AKI, while ulinastatin use was associated with a reduced incidence of CSA-AKI (OR 0.694, 95% CI 0.557-0.881, p=0.006). CSA-AKI was significantly associated with in-hospital mortality (adjusted HR: 2.218, 95% CI 1.161-4.238, p=0.016), especially in patients needing renal replacement therapy (adjusted HR: 18.683, 95% CI 8.579-40.684, p<0.001). Conclusion Mechanical ventilation duration, erythrocytes transfusion, and postoperative body temperature above 38℃ within 3 days were considered independent risk factors for CSA-AKI. The use of ulinastatin was associated with a reduced incidence of CSA-AKI.

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Section: Discussionmentioning

confidence: 99%

Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study

Xie

Wan

et al. 2017

Intern. Med.

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“…Retrospective case controlled studies found that statins reduced acute kidney injury in patients with contrast-induced nephropathy [ 92 , 93 ], whereas a prospective study did not find any beneficial effects [ 94 ]. Remarkably, a number of observational studies suggested that in the first few weeks and months of starting a statin, statins were associated with the early development of acute kidney [ 95 ]. Due to the adverse data and the lack of good prospective randomized controlled trials, there is no evidence that statins reduce the incidence of acute kidney injury.…”

Section: Introductionmentioning

confidence: 99%

Improving the outcome of kidney transplantation by ameliorating renal ischemia reperfusion injury: lost in translation?

et al. 2016

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Kidney transplantation is the treatment of choice in patients with end stage renal disease. During kidney transplantation ischemia reperfusion injury (IRI) occurs, which is a risk factor for acute kidney injury, delayed graft function and acute and chronic rejection. Kidneys from living donors show a superior short- and long-term graft survival compared with deceased donors. However, the shortage of donor kidneys has resulted in expansion of the donor pool by using not only living- and brain death donors but also kidneys from donation after circulatory death and from extended criteria donors. These grafts are associated with an increased sensitivity to IRI and decreased graft outcome due to prolonged ischemia and donor comorbidity. Therefore, preventing or ameliorating IRI may improve graft survival. Animal experiments focus on understanding the mechanism behind IRI and try to find methods to minimize IRI either before, during or after ischemia. This review evaluates the different experimental strategies that have been investigated to prevent or ameliorate renal IRI. In addition, we review the current state of translation to the clinical setting. Experimental research has contributed to the development of strategies to prevent or ameliorate IRI, but promising results in animal studies have not yet been successfully translated to clinical use.

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“…[ 39 ] Statins have been shown to improve basal NO activity and NO-dependent endothelium-derived vasodilatation in healthy volunteers and in patients with heart disease. [ 40 ] They have also been shown to significantly ameliorate endothelial dysfunction in patients with carotid artery disease (CAD) via the regulation of endothelial NO synthase function and phosphatidylinositide 3-kinase/Akt signaling. [ 41 – 43 ] Atorvastatin increases NO availability, prevents the production of oxygen free radicals, and downregulates the expression of cyclooxygenase 2.…”

Section: Discussionmentioning

confidence: 99%

The renoprotective effects of simvastatin and atorvastatin in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Liu²,

Xie³

et al. 2017

Medicine

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Some statins, such as atorvastatin, have proven renoprotective effects. The comparative renoprotective potential of simvastatin is less clear. This study aimed to compare the renoprotective effects of simvastatin with atorvastatin in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This observational study examined the medical records of 271 patients who were treated at the Guangdong Cardiovascular Institute from April 2004 to February 2008. Patients had received either 40 mg simvastatin (n = 128) or 20 mg atorvastatin (n = 143), daily, for a period of at least 6 months following PCI. Declined renal function (DRF) was defined at the occurrence of chronic kidney disease (CKD) or elevated CKD stages at 6-months post-PCI. Results showed that the incidence of DRF was similar among patients taking simvastatin or atorvastatin (25.00% vs 26.57%, respectively). Kaplan–Meier survival analysis showed that patients who developed DRF had a higher incidence of mortality and major adverse cardiovascular events (MACEs) than those without DRF (17.41% vs 28.57%, P = .0308). Multivariate logistic regression analysis identified diabetes and baseline estimated glomerular filtration rate as independent risk factors for DRF. Collectively, our results indicate that simvastatin has comparable renoprotective effects to atorvastatin in ACS patients undergoing PCI. Further studies are warranted to confirm the comparative renoprotective effects of statins.

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Do statins prevent acute kidney injury?

Cited by 7 publications

References 98 publications

Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study

Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study

Improving the outcome of kidney transplantation by ameliorating renal ischemia reperfusion injury: lost in translation?

The renoprotective effects of simvastatin and atorvastatin in patients with acute coronary syndrome undergoing percutaneous coronary intervention

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