HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass

Lewicki, Michelle C.; Ng, Irene; Schneider, Antoine

doi:10.1002/14651858.cd010480.pub2

Cited by 44 publications

(28 citation statements)

References 107 publications

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“…A recent meta-analysis by Wang et al, including 11 studies, showed that preoperative statin treatment reduced the incidence of post-operative AKI by 13% (8). However, the results of this meta-analysis should be interpreted with caution as the presence of supporting evidence of attenuation of AKI after cardiac surgery with preoperative statin treatment has been challenged (9). Prior studies examining specifically shortterm initiation of statins have also showed contradictory results.…”

mentioning

confidence: 86%

Does high-dose perioperative use of statins ameliorate acute kidney injury following cardiac surgery?

Groenendael

Pickkers²

2016

J. Thorac. Dis.

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Acute kidney injury (AKI) is a well-known, frequent complication in patients after cardiac surgery, occurring in 7% to 40%, depending on its definition (1). Subsequently, it is independently associated with substantial morbidity [such as need for renal replacement therapy, longer length of hospital stay and progression of chronic kidney disease (CKD)] and mortality (2). Even a minimal increase in postoperative serum creatinine is associated with an increased mortality in cardiac surgery patients (3).Due to the complex pathophysiology of AKI with multiple contributing factors, exact mechanisms are not yet fully understood and challenges remain concerning early recognition, prevention and treatment. Currently, therapy consist of supportive measures, while numerous studies and attempts on (pharmaceutical) treatment have failed to show beneficial effects in (cardiac surgery induced) AKI (4).Lipid lowering therapy with 3-hydroxy-3-methylglutarylCoA reductase inhibitors (statins) is a widely used therapy to lower cholesterol levels and prevent cardiovascular events. Its use among patients who undergo cardiac surgery is associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery (5). Besides the lipid lowering effects of statins, established pleiotropic anti-inflammatory and endothelial stabilizing effects of statins are believed to (indirectly) contribute to this protective effect after cardiac surgery (6).As inflammatory pathways and endothelial dysfunction are also believed to play a major role in the development of AKI (7), it has been proposed that short-term use of statins could possibly improve renal outcome. Given this rationale, multiple, mostly observational, studies regarding the effect of statin use on renal outcome after cardiac surgery have been conducted and reported contradictory results. A recent meta-analysis by Wang et al., including 11 studies, showed that preoperative statin treatment reduced the incidence of post-operative AKI by 13% (8). However, the results of this meta-analysis should be interpreted with caution as the presence of supporting evidence of attenuation of AKI after cardiac surgery with preoperative statin treatment has been challenged (9). Prior studies examining specifically shortterm initiation of statins have also showed contradictory results. In a pilot randomized controlled trial (RCT) (n=100) short-term use of statins did not affect AKI incidence (10), while in a recent observational study of 17,000 patients who underwent cardiac surgery, a 22% lower relative risk for the development of AKI was observed in patients on statins in adjusted analyses (11).In this respect, Billings et al. recently tested the hypothesis that short-term high-dose perioperative use of statins would reduce AKI following cardiac surgery for both patients naïve to statin treatment and for patients already on chronic statin therapy. The primary endpoint was diagnosis of AKI according to the criteria form the acute kidney injury network (AKIN), defined by an i...

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confidence: 86%

Does high-dose perioperative use of statins ameliorate acute kidney injury following cardiac surgery?

Groenendael

Pickkers²

2016

J. Thorac. Dis.

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“…sogar eine erhöhte AKI-Rate bei Patienten, die perioperativ mit Statinen behandelt wurden, gezeigt werden konnte [7,34,44,85]. …”

Section: Kardiochirurgische Patientenunclassified

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

Joannidis

Klein

John

et al. 2018

Med Klin Intensivmed Notfmed

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Die akute Nierenschädigung ("acute kidney injury", AKI) ist ein komplexes Krankheitsbild, das durchschnittlich 50 % der Patienten auf Intensivstationen weltweit betrifft und mit erhöhter Morbidität und Mortalität einhergeht [32,36]. Das Spektrum der AKI reicht von einer Schädigung der Niere ohne Funktionsverlust bis zum Versagen des Organs mit der Notwendigkeit einer Nierenersatztherapie.Über die letzten Jahre wurden Diagnosekriterien für die AKI entwickelt. Die aktuellsten stellen die KDIGO-Leitlinien (KDIGO: "Kidney Disease: Improving Global Outcomes") aus dem Jahr 2012 dar, in denen auch die Klassifikation der AKI geregelt wird.

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“…The remaining four trials observed no difference in renal outcome between those receiving short-term pre-operative statins and given placebo [58][59][60][61][62][63]. Much of this is summarised in a recent metaanalysis in the Cochrane database of the impact of statins on the occurrence of AKI after procedures requiring cardiac bypass by Lewicki and colleagues [64]. The conclusion was the available data do not suggest that pre-operative statin use is associated with decreased incidence of AKI in adults in such circumstances, nor do they indicate an increased incidence of AKI.…”

Section: 2mentioning

confidence: 99%

Do statins prevent acute kidney injury?

Philips

MacPhee

2015

Expert Opinion on Drug Safety

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HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass

Abstract: HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass.

Cited by 44 publications

References 107 publications

Does high-dose perioperative use of statins ameliorate acute kidney injury following cardiac surgery?

Does high-dose perioperative use of statins ameliorate acute kidney injury following cardiac surgery?

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

Do statins prevent acute kidney injury?

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