Impact of a High Loading Dose of Atorvastatin on Contrast-Induced Acute Kidney Injury

Quintavalle, Cristina; Fiore, Danilo; Micco, Francesca De

doi:10.1016/j.jvs.2013.01.011

Cited by 33 publications

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“…CIN was defined as an increase (>10%) of serum cystatin C concentration within 24 h after contrast media exposure. Also, about 25% of patients underwent coronary angiography per se [28]. Fairly higher rates of CIN were encountered in the present study.…”

Section: Comparison With Previous Studiessupporting

confidence: 38%

Impact of High Loading Dose of Atorvastatin in Diabetic Patients with Renal Dysfunction Undergoing Elective Percutaneous Coronary Intervention: A Randomized Controlled Trial

Shehata

Hamza

2015

Cardiovascular Therapeutics

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SUMMARYIntroduction: The effectiveness of statin pretreatment in reducing the incidence of contrast-induced nephropathy (CIN) has been examined in some observational and randomized studies, yielding controversial results. Aim: This study sought to evaluate the role of atorvastatin in prevention of CIN in diabetic patients with mild-to-moderate chronic kidney disease (CKD), undergoing elective percutaneous coronary intervention (PCI). Methods: 130 patients with mean glomerular filtration rate of 48.5 AE 16 mL/min/1.73 m were prospectively enrolled, then randomly (double blind) assigned in 1:1 ratio to receive atorvastatin (80 mg daily for 48 h) or placebo. Serum creatinine and glomerular filtration rate were measured preintervention, 72 h and 10 days thereafter. An increase in serum creatinine by >0.5 mg/dL (44.2 lmol/L) or >25% of baseline value was considered as CIN. Results: Mean age of the study cohort was 56 AE 5 years (males: 62%). Mean serum creatinine level in the placebo group increased significantly 3 days after coronary intervention and declined on the 10th day to a level that did not differ significantly from the baseline level, but still higher. However, in atorvastatin group, mean serum creatinine level showed a nonsignificant rise on the third day and then decreased to a level close to the baseline one, on the 10th day. Incidence of CIN was 7.7% in atorvastatin group and 20% in the placebo group (P < 0.05). Conclusion: Atorvastatin dose of 80 mg per day for 48 h is associated with decreased incidence of CIN in diabetic patients with CKD undergoing PCI.

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Section: Comparison With Previous Studiessupporting

confidence: 38%

Impact of High Loading Dose of Atorvastatin in Diabetic Patients with Renal Dysfunction Undergoing Elective Percutaneous Coronary Intervention: A Randomized Controlled Trial

Shehata

Hamza

2015

Cardiovascular Therapeutics

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“…70 The effect of statins might be less profound in patients with baseline renal function impairment (eGFR <40 ml/min/1.73 m 2 ). 71 As observed by Quintavalle et al, 68 atorvastatin induced cell viability via reduction of proapoptotic caspase-3, JNK, and p53 activation, at the same time promoting survival signals mediated by the Akt and ERK pathways. 68 These data lend support to the current recommendations of the European Society of Cardiology (ESC), 30 suggesting the consideration of preprocedural adjuvant loading dose of statin (class IIa, level A).…”

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confidence: 78%

“…This was documented both in statin-naive patients with ACS 67 and in subjects with stable CAD. 68 The beneficial effect was observed for atorvastatin at a dose of 80 mg, 68 rosuvastatin at a dose of 40 or 20 mg, 67 and simvastatin at a dose of 80 mg. 69 The efficacy of statins was summarized by a recent meta-analysis comprising 7 randomized controlled trials (RCTs) incorporating 1399 patients, which revealed a favorable effect of statin on the rate of CI-AKI (relative risk [RR], 0.51, P = 0.001), yet with no effect on the rate of dialysis requirement. 70 The effect of statins might be less profound in patients with baseline renal function impairment (eGFR <40 ml/min/1.73 m 2 ).…”

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confidence: 97%

“…Recently, it has TABLE 3 Prevention of contrast-induced acute kidney injury 53,[57][58][59][60][61]64,68,[72][73][74][90][91][92][93][94][95][96] The limitations of HD are somewhat overcome by continuous extracorporeal blood purification techniques such as continuous venovenous hemofiltration (CVVH). Marenzi et al 82 reported that CVVH had an advantage over saline hydration in the reduction of the rate of CI-AKI (5% vs 50% respectively, P <0.001), the need for repeated RRT (3% vs 25%), the rate of in-hospital complications, and the rates of in-hospital (2% vs 14%, P = 0.02) and 1-year mortality (10% vs. 30%, P = 0.01).…”

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confidence: 99%

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Contrast-induced acute kidney injury: the dark side of cardiac catheterization

Wybraniec¹,

Mizia-Stec²,

Wiȩcek³

2015

Polish Archives of Internal Medicine

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POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ 2015; 125 (12) 938the diagnostic criteria applied, comorbidities, and the type of procedure (coronary angiography [CA]; percutaneous coronary intervention [PCI]). CI-AKI is a challenge mainly for well-developed countries, in which excessive amounts of CM are used on a daily basis. When using the definition of CI-AKI as an increase of serum creatinine concentrations (SCr) by more than 25% relative to baseline and/or by more than 0.5 mg/dl at 48 hours after PCI, the rate of CI-AKI ranged from 3.3% according to the Mayo Clinic PCI registry 6 to 13.1% as stated by Mehran et al. 7 In the largest registry by Gurm et al, 8 based on 68 573 procedures, the rate of CI-AKI was 2.5%, defined as an absolute elevation in SCr by more than 0.5 mg/dl. Still, when only clinically relevant CI-AKI requiring dialysis was considered, the incidence decreased to a range from 0.8% to 1.7%. 9 This review sought to summarize the contemporary knowledge on pathophysiology, risk factors, diagnostic markers, and management of CI-AKI, with a special interest in CI-AKI as a result of cardiac catheterization. Accordingly, the Medline and EmBase databases were queried to Introduction Contrast-induced acute kidney injury (CI-AKI), previously known as contrast--induced nephropathy (CIN), represents a specific form of acute renal function impairment triggered by the use of iodinated contrast media (CM). As CI-AKI remains the subtype of acute kidney injury (AKI), it is recommended to use common definitions of AKI, such as the 2012 KDIGO criteria, 1 RIFLE classification (Risk, Injury, Failure, Loss of Function, End-Stage Renal Disease), 2 AKI Network criteria, 3 or the definition by Harjai 4 (Supplementary material online, Table S1).The rapid development of invasive cardiology triggered a massive increase in CM exposure. Since the implementation of the first CM in the 1950s, CI-AKI has emerged as the third most common subtype of hospital-acquired renal failure (reaching 11% of all cases), after renal hypoperfusion (42%) and postoperative AKI.5 Nearly half of all cases of CI-AKI occur after invasive cardiac procedures owing to CM-related nephrotoxicity and frequently present hemodynamic instability. 5The exact rate of CI-AKI in the setting of a cardiology department varies depending on ABSTRACTThe rapidly growing number of percutaneous coronary interventions has led to a considerable improvement in the outcome of patients with acute coronary syndromes, yet concurrently exposing patients to enormous volumes of contrast media with the inherent risk of renal function impairment. The issue of contrast-induced acute kidney injury (CI-AKI) is not only associated with direct sequelae such as prolonged hospital stay, but also with increased risk of chronic kidney disease, recurrent acute coronary syndromes, cerebral ischemia, and increased mortality rate. The ubiquitous application of contrast media warrants active search for reliable risk factors, diagnostic markers, preventive measures, and therapeutic modalities th...

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“…For the prevention of CI-AKI, homedialysis 20) and the administration of N-acetylcysteine, which is an antidote for acetaminophen, 21,22) sodium bicarbonate used for the correction of acidosis derived from the proximal renal tubules, 23,24) a high dose of statin, 25) and physiologic saline 26) have been shown to be effective. Except for hemodialysis, the administration from before the procedure is necessary, but as CI-AKI is caused by exposure to contrast media, minimization of their dose is the first priority.…”

Section: Disclosure Statementmentioning

confidence: 99%

The Prevention of Renal Dysfunction in High-risk CKD Patients Undergoing Carotid Artery Stenting

Hatsuda¹,

Nakajima²,

Tanimoto³

et al. 2016

JNET

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Objective: Contrast-induced acute kidney injury is more likely to result in various morbidities than to develop into renal dysfunction. To prevent acute kidney injury from occurring, we performed hydration therapy and administered reduced contrast medium concentrations for patients with preexisting high-risk chronic kidney disease (CKD; stage 3 or 4). The objective of this study was to evaluate the effectiveness of these procedures.Methods: Fifty-one sites underwent carotid artery stenting. We divided the patients into two groups by CKD stage (group A: stage 1-2, group B: stage 3-4) and reduced the dose of contrast medium during the intervention for the patients in group B.Furthermore, intravenous hydration peri-intervention was performed in patients with CKD stage 3b or 4. The differences in the estimated glomerular filtration rate (eGFR) between before and after therapy, were retrospectively assessed. Results:There was a significant difference in the two groups in terms of the dose of contrast medium administered (group A: 58.3 ml ± 18.5 ml, group B: 32.8 ml ± 21.5 ml, p <0.01). Moreover, there was a significant difference between the two groups in terms of the difference in eGFR before and after the intervention (group A: -4.87 ml ± 8.23 ml, group B: 1.03 ml ± 6.07 ml, p <0.05). Conclusion:Our findings indicate the effectiveness of a reduction in the dose contrast medium and hydration for the prevention of renal dysfunction in high-risk CKD patients undergoing carotid artery stenting.Keywords▶ carotid artery stenting, chronic kidney disease, low dose of contrast medium, hydration, contrast-induced acute kidney injury

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Impact of a High Loading Dose of Atorvastatin on Contrast-Induced Acute Kidney Injury

Cited by 33 publications

References 0 publications

Impact of High Loading Dose of Atorvastatin in Diabetic Patients with Renal Dysfunction Undergoing Elective Percutaneous Coronary Intervention: A Randomized Controlled Trial

Impact of High Loading Dose of Atorvastatin in Diabetic Patients with Renal Dysfunction Undergoing Elective Percutaneous Coronary Intervention: A Randomized Controlled Trial

Contrast-induced acute kidney injury: the dark side of cardiac catheterization

The Prevention of Renal Dysfunction in High-risk CKD Patients Undergoing Carotid Artery Stenting

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