Preventive Effect of Pretreatment with Pitavastatin on Contrast-Induced Nephropathy in Patients with Renal Dysfunction Undergoing Coronary Procedure: PRINCIPLE-II Randomized Clinical Trial

Abstract

This study aimed to evaluate the efficacy of pitavastatin pretreatment on contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) after a coronary procedure. This was a prospective, randomized, double-blinded, placebo-controlled, multicenter clinical trial. All consecutive 70 patients with CKD (eGFR < 60 mL/min/1.73 m2) were enrolled and randomized into two groups. Group I consisted of patients who were treated with statins (pitavastatin 4 mg/day) for seven days before and three days after the procedure (n = 37, 52.9%), and group II consisted of patients who were treated with a placebo (n = 33, 47.1%). The primary endpoint was the incidence of CIN, and the secondary endpoints were the change in serum creatinine (∆sCr) level and estimated glomerular filtration rate (∆eGFR) after the procedure. The mean age of the patients (males, 74%) was 70.4 ± 9.0 years. After the coronary procedure, the incidence of CIN was lower in group I than in group II, but the difference was not significant (5.4% vs. 9.1%, p = 0.661). The maximal ∆sCr was lower and the maximal ∆eGFR was higher in group I than in group II, but the difference was not significant (−0.11 ± 0.53 mg/dL and −0.04 ± 0.33 mg/dL, p = 0.678; 4.3 ± 11.2 mL/min/1.73 m2 and −2.9 ± 20.4 mL/min/1.73 m2, p = 0.161, respectively). This study showed the possibility of a clinical benefit of pretreatment with a high dose of pitavastatin for the prevention of CIN in patients with CKD after coronary procedure (ClinicalTrials.gov Identifier: NCT01871792).

Emergency angiography for trauma patients and potential association with acute kidney injury

“…Given that preprocedural hydration with saline or bicarbonate has been shown to prevent PC-AKI [34][35][36], restoration of intravascular volume should be achieved before emergency angiography. As anti-inflammatory medications, such as statins, have shown promising results for the prevention of PC-AKI in clinical studies on coronary angiography [37], this potential treatment should be investigated as an adjunct in trauma patients who require an angiography. Urine alkalization is scheduled to be investigated in an upcoming randomized controlled trial and may become an option for PC-AKI prevention in the near future [38].…”

Renoprotective Effect of Pitavastatin against TAA-Induced Renal Injury: Involvement of the miR-93/PTEN/AKT/mTOR Pathway

“…While previous studies have shown the nephroprotective efects of statins, including pitavastatin [45][46][47][48][49][50][51], the specifc involvement of the miR-93/PTEN/Akt/mTOR pathway in mediating these efects has not been elucidated in vivo in the context of xenobiotic-induced kidney injury. Our study is the frst to demonstrate that pitavastatin attenuates TAAinduced kidney damage in rats by regulating this essential signaling cascade.…”