Effect of statin therapy on contrast-induced nephropathy after coronary angiography: A meta-analysis

Pappy, Reji; Stavrakis, Stavros; Hennebry, Thomas A.; Abu‐Fadel, Mazen

doi:10.1016/j.ijcard.2011.05.045

Cited by 51 publications

(41 citation statements)

References 38 publications

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“…Although it remains uncertain whether statins lower the risk of contrast-induced AKI or are associated with AKI when used in high doses, they have been consistently shown to lower major adverse cardiovascular events in most populations (37)(38)(39)(40)(41)(42)(43)(44)(45). To our knowledge, there are no published reports of AKI associated with b-blocker use.…”

Section: Discussionmentioning

confidence: 99%

Contrast-Associated AKI and Use of Cardiovascular Medications after Acute Coronary Syndrome

Leung¹,

Pannu

Tan

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives AKI after coronary angiography is associated with poor long-term outcomes. The relationship between contrast-associated AKI and subsequent use of prognosis-modifying cardiovascular medications is unknown.Design, setting, participants, & measurements A cohort study of 5911 participants 66 years of age or older with acute coronary syndrome who received a coronary angiogram in Alberta, Canada was performed between November 1, 2002, and November 30, 2008. AKI was identified according to Kidney Disease Improving Global Outcomes AKI criteria.Results In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2-3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65; 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34; 95% confidence interval, 0.23 to 0.48, respectively). Subsequent statin and b-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2-3 AKI (adjusted odds ratio, 0.44; 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46; 95% confidence interval, 0.31 to 0.66, respectively). These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria; 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI.Conclusions Strategies to optimize the use of cardiac medications in people with AKI after coronary angiography might improve care.

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Section: Discussionmentioning

confidence: 99%

Contrast-Associated AKI and Use of Cardiovascular Medications after Acute Coronary Syndrome

Leung¹,

Pannu

Tan

et al. 2014

Clinical Journal of the American Society of Nephrology

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Section: Meta-analyses Of Small Statin Trials For Prophylaxis Of Ci-akimentioning

confidence: 99%

“…In 2011, Pappy et al [17] performed a meta-analysis looking at the benefit of statin therapy in CI-AKI, including 10 trials (3 randomized controlled trials and 7 nonrandomized studies). They did not show a significant benefit in the randomized trials but they did show a marginal benefit in the incidence of CI-AKI in the nonrandomized studies [17]. Also in 2011, Zhang et al [18] performed a meta-analysis including 4 trials and 751 patients and found no significant improvement in CI-AKI in patients pretreated with a statin compared to nonstatin controls, but they did note a slight improvement in serum creatinine [18].…”

Section: Meta-analyses Of Small Statin Trials For Prophylaxis Of Ci-akimentioning

confidence: 99%

Statins for the Prevention of Contrast-Induced Acute Kidney Injury

Ball¹,

McCullough²

2014

Nephron Clin Pract

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Acute kidney injury (AKI) is a common medical problem, especially in patients undergoing cardiovascular procedures. The risk of kidney damage has multiple determinants and is often related to or exacerbated by intravenous or intra-arterial iodinated contrast. Contrast-induced AKI (CI-AKI) has been associated with an increased risk of subsequent myocardial infarction, stroke, the development of heart failure, rehospitalization, progression of chronic kidney disease, end-stage renal disease, and death. Statins have been studied extensively in the setting of chronic kidney disease and they have been shown to reduce albuminuria, but they have had no effect on the progressive reduction of glomerular filtration or the need for renal replacement therapy. Several meta-analyses have shown a protective effect of short-term statin administration on CI-AKI and led to two large randomized controlled trials evaluating the role of rosuvastatin in the prevention of CI-AKI in high-risk patients with acute coronary syndrome and diabetes mellitus. Both trials showed a benefit of rosuvastatin prior to contrast administration in a statin-naive patient population. In aggregate, these studies support the short-term use of statins specifically for the prevention of CI-AKI in patients undergoing coronary angiography with or without percutaneous coronary intervention.

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“…Patients on baseline statin therapy had a 13% reduced risk of developing CIN, and a 35% reduction in the incidence of hemodialysis (P=0.03 for both). However, the data from ARMYDA-CIN 53 and Khanal et al 54 was challenged by two meta-analyses, 55,56 both of which failed to demonstrate a protective role of statins in reducing the incidence of CIN among patients undergoing coronary angiography, despite observed reductions in postprocedure serum creatinine.…”

Section: Statins In Contrast-induced Nephropathymentioning

confidence: 99%

The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in renal disease

Gomez¹,

Mihos²,

Pineda³

et al. 2014

IJNRD

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Abstract:It is well known that statins exert their main effect by inhibiting cholesterol synthesis through the inhibition of the 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme. The pleiotropic effects of statins, which are independent of their inhibition of cholesterol synthesis, have explained many of the beneficial effects of these drugs in a variety of disorders such as malignancies, infection, and sepsis, as well as in cardiovascular and rheumatologic disorders. However, the role of these drugs in renal disorders remains controversial. In the present review, we examine the most recent findings involving statins and renal disease among different clinical scenarios, including chronic kidney disease, contrast-induced nephropathy, renal injury after coronary artery bypass surgery, and renal transplant patients.

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Effect of statin therapy on contrast-induced nephropathy after coronary angiography: A meta-analysis

Cited by 51 publications

References 38 publications

Contrast-Associated AKI and Use of Cardiovascular Medications after Acute Coronary Syndrome

Contrast-Associated AKI and Use of Cardiovascular Medications after Acute Coronary Syndrome

Statins for the Prevention of Contrast-Induced Acute Kidney Injury

The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in renal disease

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