Impact of High Loading Dose of Atorvastatin in Diabetic Patients with Renal Dysfunction Undergoing Elective Percutaneous Coronary Intervention: A Randomized Controlled Trial

Shehata, Mohamed; Hamza, May

doi:10.1111/1755-5922.12108

Cited by 24 publications

(23 citation statements)

References 33 publications

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“…In a subgroup analysis of this study, rosuvastatin had a protective effect among female diabetic patients with CKD [116]. Similarly, a single high dose of atorvastatin (80 mg) administered within 24 h before exposure to intravenous contrast was effective in reducing the rate of AKI in diabetic patients with renal dysfunction [117,118]. The protective effect of statins has been confirmed in multiple metaanalyses [119][120][121].…”

Section: Pharmacologic Interventions For Management Of Acute Kidney Isupporting

confidence: 51%

Acute Kidney Injury

Alkhunaizi¹

2019

Aspects in Continuous Renal Replacement Therapy

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Acute kidney injury (AKI), previously named acute renal failure, is characterized by abrupt deterioration in renal function. The incidence of AKI has increased lately, both in the hospital and community setting. It is estimated that more than 13 million people are affected by AKI annually worldwide. Despite all the advances in the field, AKI still carries a high mortality rate. In addition to mortality, AKI is an important risk factor for the development of chronic kidney disease. In this chapter, various aspects of AKI will be discussed including definition and staging, etiology, pathophysiology, clinical presentation, diagnosis, management, prognosis, and prevention.

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Section: Pharmacologic Interventions For Management Of Acute Kidney Isupporting

confidence: 51%

Acute Kidney Injury

Alkhunaizi¹

2019

Aspects in Continuous Renal Replacement Therapy

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“…An RCT in 410 CKD patients showed less CA-AKI in patients randomised to a single dose of atorvastatin within 24 h before contrast exposure compared to the control group (4.5% vs. 17.8%, p = 0.005) [257]. Two more recent RCTs found similar effects of statins in diabetics with CKD [258, 259]. These positive findings were confirmed by several meta-analyses combining studies in patients undergoing coronary angiography [260–263] (ESM_2 Table S14).…”

Section: Statinsmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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“…Some studies have demonstrated that statins lowered PC-AKI risk (27–29). For example, a placebo-controlled, double-blind clinical trial with 220 subjects found 80 mg of atorvastatin combined with NAC and standard intravenous hydration decreased the risk of renal injury within 24 hours of percutaneous coronary intervention compared to a combination of placebo, NAC and hydration.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention

Takahashi

Kallmes

Fleming

et al. 2017

Journal of Vascular and Interventional Radiology

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Purpose To determine the incidence, predictors and clinical outcomes of post-contrast acute kidney injury (PC-AKI) following renal artery stent placement for atherosclerotic renal artery stenosis. Materials and Methods This retrospective study reviewed 1,052 patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis. In total, 437 patients with follow-up were included in this study. Mean age was 73.6 ± 8.3 years. Post-contrast acute kidney injury was defined as an absolute serum creatinine increase ≥0.3 mg/dL or percentage increase in serum creatinine ≥50% within 48 hours of intervention. Logistic regression analysis was performed to identify risk factors for PC-AKI. The cumulative proportion of patients who died or went on to hemodialysis was determined using Kaplan-Meier survival analysis. Results Mean follow-up was 71.1±68.4 months. Twenty-six patients (5.9%) developed PC-AKI. Patients who developed PC-AKI had significantly higher levels of baseline proteinuria compared to those who did not (Odds ratio 1.38; 95% CI 1.11–1.72; P=0.004). Prehydration, chronic kidney disease stage, baseline GFR, statin medications, contrast volume and iodine load were not associated with higher rates of PC-AKI. Dialysis-free survival and mortality rates were not significantly different between patients with and without PC-AKI (P=0.50 and P=0.17, respectively). Conclusion Elevated baseline proteinuria was the only predictor for PC-AKI in patients undergoing renal artery stent placement. Patients who developed PC-AKI were not at greater risk for hemodialysis or death.

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Impact of High Loading Dose of Atorvastatin in Diabetic Patients with Renal Dysfunction Undergoing Elective Percutaneous Coronary Intervention: A Randomized Controlled Trial

Cited by 24 publications

References 33 publications

Acute Kidney Injury

Acute Kidney Injury

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention

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