Statin Use Associates with a Lower Incidence of Acute Kidney Injury after Major Elective Surgery

Molnar, Amber O.; Coca, Steven G.; Devereaux, P. J.; Jain, Arsh K.; Kitchlu, Abhijat; Luo, Jin; Parikh, Chirag R.; Paterson, J. Michael; Siddiqui, Nausheen; Wald, Ron; Walsh, Michael; Garg, Amit X.

doi:10.1681/asn.2010050442

Cited by 110 publications

(101 citation statements)

References 58 publications

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“…In a large meta-analysis (n = 31,725), preoperative statin exposure significantly reduced early mortality (OR = 0.57), stroke (OR = 0.74) and atrial fibrillation (OR = 0.6) after cardiac surgery [174]. In other study, which included 213,347 older patients who underwent major elective surgery, statin therapy was associated with 16% lower risk of AKI and 21% lower risk of mortality [175]. In a recent single-institution study 7,777 of non-cardiac operations were analyzed [176].…”

Section: Major Surgery and Statin Intolerancementioning

confidence: 95%

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Banach

Rizzo²,

Tóth

et al. 2015

Expert Opinion on Drug Safety

182

204

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Section: Major Surgery and Statin Intolerancementioning

confidence: 95%

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Banach

Rizzo²,

Tóth

et al. 2015

Expert Opinion on Drug Safety

182

204

View full text Add to dashboard Cite

“…The median number of pregnancies per mother during the study period was 1 (interquartile range [IQR] 1-2; range 1-11). The median maternal age at delivery was 30 years (IQR [26][27][28][29][30][31][32][33][34]. The prevalence of at least one recorded preexisting medical condition, including hypertension, diabetes mellitus, or chronic kidney disease, was 5.3%.…”

Section: Pregnancies In Ontario Canadamentioning

confidence: 99%

“…25 Maternal cause of death was determined from the Ontario Registrar General Death database, which contains information on all deaths registered in Ontario. 26 We have used these databases in previous studies to research health outcomes and health services including those related to AKI-D. [29][30][31][32] All variables used in this study were complete, with minor exceptions detailed in Supplemental Table 3.…”

Section: Data Sourcesmentioning

confidence: 99%

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Hildebrand

Liu

Shariff

et al. 2015

Journal of the American Society of Nephrology

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Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. We conducted a retrospective population-based cohort study of all consecutive pregnancies over a 15-year period (1997-2011) in Ontario, Canada, and describe the incidence and outcomes of AKI treated with dialysis during pregnancy or within 12 weeks of delivery. Of 1,918,789 pregnancies, 188 were complicated by AKI treated with dialysis (incidence: 1 per 10,000 [95% confidence interval, 0.8 to 1.1]). Only 21 of 188 (11.2%) women had record of a preexisting medical condition; however, 130 (69.2%) women experienced a major pregnancy-related complication, including preeclampsia, thrombotic microangiopathy, heart failure, sepsis, or postpartum hemorrhage. Eight women died (4.3% versus 0.01% in the general population), and seven (3.9%) women remained dialysis dependent 4 months after delivery. Low birth weight (,2500 g), small for gestational age, or preterm birth (,37 weeks' gestation) were more common in pregnancies in which dialysis was initiated (35.6% versus 14.0%; relative risk, 3.40; 95% confidence interval, 2.52 to 4.58). There were no stillbirths and fewer than five neonatal deaths (,2.7%) in affected pregnancies compared with 0.1% and 0.8%, respectively, in the general population. In conclusion, AKI treated with dialysis during pregnancy is rare and typically occurs in healthy women who acquire a major pregnancy-related medical condition such as preeclampsia. Many affected women and their babies have good short-term outcomes. 26: 3085-3091, 201526: 3085-3091, . doi: 10.1681 Pregnancy-related AKI is associated with significant morbidity and mortality inyoung and often otherwise healthy women. 1,2 Since the 1960s, the incidence of pregnancy-related AKI in developed countries has declined from 1 in 3000 to 1 in 18,000. 1 This trend has been closely linked to improved obstetrical care and dramatic reductions in first-trimester AKI attributable to septic abortions. 2 However, these trends are less relevant in contemporary populations. The changing risk profile of pregnant North American women includes lower parity, older age, higher body mass index, and greater comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease, as well as increased use of reproductive technologies resulting in multiple gestations. These changes may have a unique impact on the incidence, etiology, and outcomes of pregnancy-related AKI. [3][4][5][6][7] J Am Soc Nephrol

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“…These databases have been used extensively to research health outcomes. [18][19][20][21][22] Whenever possible, we defined patient characteristics, surgery characteristics and outcomes using database codes that have been proven reliable when compared with manual chart review (Ap pendices 1 and 2, available at www .cmaj .ca /lookup /suppl /doi :10.1503/cmaj.110895/-/DC1).…”

Section: Data Sourcesmentioning

confidence: 99%

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

Siddiqui

Coca

Devereaux

et al. 2012

CMAJ

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119

116

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Research CMAJBackground: Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time. Methods:We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function.Results: A total of 552 672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time.Interpretation: The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed. Abstract

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Statin Use Associates with a Lower Incidence of Acute Kidney Injury after Major Elective Surgery

Cited by 110 publications

References 58 publications

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

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