Efficacy of short-term moderate or high-dose statin therapy for the prevention of contrast-induced nephropathy in high-risk patients with chronic kidney disease: systematic review and meta-analysis

Zhou, Yanlin; Chen, Liqun; Du, Xuqin

doi:10.6061/clinics/2021/e1876

Cited by 6 publications

(5 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rate of CI-AKI decreased from 10.1% to 3.2% ( P < .001), with a 74.1% compliance rate for administering a high-dose statin and 73.4% compliance with meeting all 5 components of the renal protection bundle after implementation. This decrease in the rate of CI-AKI was consistent with that reported in multiple other studies 2,6,13-16,22-26 . Studies conducted on the National Cardiovascular Data Registry reported CI-AKI rates between 7% and 8% in patients undergoing PCI 27,28 .…”

Section: Discussionsupporting

confidence: 89%

“…This decrease in the rate of CI-AKI was consistent with that reported in multiple other studies. 2,6,[13][14][15][16][22][23][24][25][26] Studies conducted on the National Cardiovascular Data Registry reported CI-AKI rates between 7% and 8% in patients undergoing PCI. 27,28 Our CI-AKI incidence rate of 3.2% falls well below the national data benchmark and demonstrates significant improvement from the 10.1% preintervention.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography

Jones¹,

Tuite²,

Guttendorf³

2023

Dimens Crit Care Nurs

View full text Add to dashboard Cite

Background Development of contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity, mortality, hospital length of stay, and overall health care costs. Objectives The purpose of this project was to evaluate a clinical practice change—the addition of high-dose statin therapy to standard renal protection measures—in adults undergoing acute cardiac catheterization procedures and assessing its effect on CI-AKI. Method The evaluation was a pretest/posttest descriptive design. Adult patients undergoing acute cardiac catheterization procedures were evaluated for the rate of CI-AKI before (10 months preimplementation, N = 283) and after (10 months postimplementation, N = 286) a recent practice change that added high-dose statin therapy (within 24 hours of dye exposure) to a standard renal protection bundle (intravenous fluids, maximum dye calculations, and avoidance of nephrotoxic medications). Outcomes included the rate of CI-AKI, stage of acute kidney injury, need for new hemodialysis, discharge disposition (alive or died in the hospital), and hospital length of stay. Results Patients in the postintervention group that received renal protection bundle with high-dose statin had significantly lower incidence of CI-AKI (10.1% pre vs 3.2% post; P < .001). There were no significant differences in hospital length of stay, need for new hemodialysis, or mortality. Administration of high-dose statin within 24 hours of the cardiac catheterization procedure improved significantly (19.4% pre vs 74.1% post; P < .001). Adherence to all 5 components of the renal bundle improved post intervention (17% pre vs 73.4% post; P < .001). Discussion The addition of a high-dose statin in addition to existing renal protective measures in patients with acute cardiac procedures is associated with a decreased incidence of CI-AKI.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography

Jones¹,

Tuite²,

Guttendorf³

2023

Dimens Crit Care Nurs

View full text Add to dashboard Cite

show abstract

“…Statins have pleiotropic effects, including causing improvements in vascular tone by increasing endothelial NO production and antiinflammatory and antioxidant effects that can contribute to renoprotection in CIN [ 136 , 137 , 138 ]. A meta-analysis by Zhou et al of seven RCTs with 4256 patients demonstrated that short-term moderate or high-dose statin pretreatment reduced the occurrence of CIN [ 139 ]. Of note, the subgroup analysis in that study revealed that statin pretreatment exhibited a preventive effect in patients with both CKD and diabetes, but it did not reduce the risk of CIN in non-diabetic patients with CKD.…”

Section: Managementmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

View full text Add to dashboard Cite

Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

show abstract

“…The results suggested a notably lower risk of CIN development in patients pretreated with statins compared to those pre-treated with placebo (RR=0.57, 95% CI=0.43-0.76, P = 0.000). Serum creatinine concentrations were lower in the statin group than in the placebo group 48 h after angiography (SMD=-0.15, 95% CI= -0.27 to -0.04, P = 0.011) (28).…”

Section: Discussionmentioning

confidence: 85%

The effects of atorvastatin on contrast-induced acute kidney injury; a systematic review and meta-analysis on clinical trials

et al. 2023

View full text Add to dashboard Cite

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a major acute renal failure that can be prevented by atorvastatin administration. This study aims to evaluate the association between atorvastatin use and CI-AKI incidence using a systematic review and meta-analysis approach. Materials and Methods: Several international databases, including Cochrane, Web of Science, Scopus, ProQuest, PubMed, and the Google Scholar search engine, were queried in this study. STATA 14 software was conducted to analyze the data. In this study, standardized mean difference (SMD) index was conducted to investigate the relationship between atorvastatin and serum creatinine level. Results: Twelve clinical trials with a total sample size of 3299 were retrieved. The effect of atorvastatin on serum creatinine levels indicated a SMD of -2.26 (95% CI: -2.53, -1.98) at a dose of 20 mg/kg, -0.76 (95% CI: -1.47, -0.05) at a dose of 40 mg/kg, -2.69 (95% CI: -2.96, -2.42) at a dose of 60 mg/ kg, and -0.03 (95% CI: -0.14, 0.09) at a dose of 80 mg/kg. The effect of atorvastatin use on serum creatinine levels achieved a SMD of -2.72 (95% CI: -3.02, -2.43) in the 40-49 years age group and a SMD of -0.96 (95% CI: -1.73, -0.19) in the 50-59 years age group. The effect of high-dose atorvastatin therapy in reducing the serum creatinine levels, compared to low-dose therapy, was a SMD of -0.54 (95% CI: -1.03, -0.04). However, estimates for the effect of atorvastatin compared to rosuvastatin and placebo showed a SMD of -0.26 (95% CI: -0.76, 0.24) and -1.23 (95% CI: -2.22, -0.25), respectively. The effect of atorvastatin on blood urea nitrogen (BUN) and high-sensitivity C-reactive protein (hs-CRP) levels relative to the comparison group was a SMD of -1.10 (95% CI: -1.61, -0.58) and -1.36 (95% CI: -2.30, -0.42) respectively. Conclusion: Pre-treatment with atorvastatin is effective in CI-AKI prevention. High-dose atorvastatin administration at younger ages provides the best outcome for preventing CI-AKI. Meta-analysis Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID: CRD42023397276, available at https:// www.crd.york.ac.uk/prospero/#recordDetails).

show abstract

Efficacy of short-term moderate or high-dose statin therapy for the prevention of contrast-induced nephropathy in high-risk patients with chronic kidney disease: systematic review and meta-analysis

Abstract: Zhou YL, Chen LQ, Du XG. Efficacy of short-term moderate or high-dose statin therapy for the prevention of contrast-induced nephropathy in high-risk patients with chronic kidney disease: systematic review and meta-analysis. Clinics (Sao Paulo).

Cited by 6 publications

References 33 publications

Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography

Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

The effects of atorvastatin on contrast-induced acute kidney injury; a systematic review and meta-analysis on clinical trials

Contact Info

Product

Resources

About