Benefit of statin pretreatment in prevention of contrast-induced nephropathy in different adult patient population: systematic review and meta-analysis

Abstract

ObjectivePrevious studies have suggested that statin pretreatment prevents contrast-induced nephropathy (CIN). However, single randomised trials are limited in their number of patients. This meta-analysis aims to assess the role of statin use in CIN prevention, as well as to determine patient subgroups that will benefit from statin pre-treatment.MethodologyWe searched PubMed, EMBASE, Web of science and the Cochrane Central Register of Controlled Trials databases for randomised controlled trials (RCT) comparing statin pretreatment versus placebo for preventing CIN. Our main outcome was the risk of CIN within 1–5 days after contrast administration.ResultsData analysed from nine randomised studies with a total of 5143 patients, where 2559 received statins and 2584 received placebo, showed that statin pretreatment was associated with significant reduction in risk of CIN (MH-RR=0.47, 95% CI 0.34 to 0.64, Z=4.49, p<0.00001). This beneficial effect of statin was also seen in patients with baseline renal impairment (MH-RR=0.46, 95% CI 0.29 to 0.72, p=0.0008) and also those who were cotreated with NAC (MH-RR=0.46, 95% CI 0.25 to 0.83, p=0.01).ConclusionsStatin pretreatment leads to significant reduction in CIN, and should be strongly considered in all patients who are planned for diagnostic and interventional procedures involving contrast-media administration.

Proteinuria and Reduced Estimated Glomerular Filtration Rate Are Independent Risk Factors for Contrast-Induced Nephropathy After Cardiac Catheterization

“…As for statins, the present study did not show the beneficial effect of statin use on CIN development. Although the recent meta-analysis indicated that statin use reduces the incidence of CIN, 21 another one did not identify a beneficial effect of statin on prevention of CIN. 22 Further studies are necessary to elucidate the effect of drugs on the development of CIN.…”

Prevalencia y pronóstico de la nefropatía tras intervencionismo coronario percutáneo de pacientes con síndrome coronario agudo y función renal normal

“…Los datos analizados a partir de nueve estudios aleatorizados con un total de 5143 pacientes mostraban que el tratamiento previo con estatinas se asociaba con una reducción significativa del riesgo de NIC. El efecto beneficioso de las estatinas se observaba tanto en pacientes con función renal normal como en pacientes con insuficiencia renal e independientemente de la administración concomitante de N-acetilcisteína 122 .…”

Imaging patients with renal impairment

“…A meta-analysis of nine such randomized studies published in 2014 concluded that statin therapy given prior to coronary angiography or percutaneous coronary intervention reduces the incidence of CIN [72]. This conclusion was found to hold true regardless of the presence of renal impairment, the type of iodinated contrast agent used, or the use of concomitant NAC therapy [72]. The exact mechanism is unclear, though it may be related to the antioxidant and anti-inflammatory properties of statins and/or their role in preventing renal hypoperfusion [73,74].…”