Statins for the Prevention of Contrast-Induced Acute Kidney Injury

Abstract

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.

Statins for primary prevention of cardiovascular disease and the risk of acute kidney injury

“…This tubular toxicity has been reported in rare case reports, sometimes associated with tubulointerstitial nephritis . Nevertheless, randomized trials have shown that statins may also have renoprotective effects, especially in diabetic patients, even when prescribed at high doses, or when given for prevention of contrast‐induced AKI . Of note, a meta‐analysis showed similar renoprotective effects in high CVD risk patients treated with atorvastatin and rosuvastatin prescribed at commonly used doses .…”

Investigation the effects of cilostazol and rosuvastatin on kidney and heart: An experimental acute kidney and heart injury model

“…[3,[12][13][14] In a study, Tai et al [12] created an experimental model with bilateral kidney I/R injury and examined cardiac function. They found that kidney I/R injury was associated with cardiac dysfunction and niacin reduced myocardial oxidative stress using indicators such as serum troponin, urea, creatinine, and malondialdehyde.…”

“…However, kidney TNF-a immunoreactivity in I/R+CIL+ROS group was found to be significantly increased, compared to the control Statins have preventive effects on myocardial and kidney injury, following ischemic and inflammatory processes such as acute coronary syndrome, percutaneous coronary intervention, and cardiovascular surgery. [14,[19][20][21][22] Several studies have shown that atorvastatin and rosuvastatin protects kidney, improving glomerular filtration rate and reducing proteinuria, and atorvastatin may even be more effective in reducing proteinuria. [23] In a study, the rats were subjected to 30 min myocardial ischemia, following an 18-hour intraperitoneal rosuvastatin at a dose of 0.1 to 5 mg/kg.…”

Do statins prevent acute kidney injury?

“…The ensuing decrease in renal blood flow may exceed 50% and last for some hours causing an ischaemic and ultimately severe reperfusion injury [87]. Statins have been shown to decrease this risk in a number of studies and meta-analyses [88][89][90][91][92]. The presumed benefit of short term, sometimes high intensity statin use is thought to be conferred by an improvement in renal perfusion secondary to the effects of statins on the production of NO.…”