Preoperative Statin Administration Is Associated With Lower Mortality and Decreased Need for Postoperative Hemodialysis in Patients Undergoing Coronary Artery Bypass Graft Surgery

Huffmyer, Julie L.; Mauermann, William J.; Thiele, Robert H.; Jennie, Z.; Nemergut, Edward C.

doi:10.1053/j.jvca.2008.11.005

Cited by 59 publications

(41 citation statements)

References 27 publications

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“…[27][28][29][30][31][32] As well, in some observational studies, statin use was associated with fewer renal events (sample sizes of 77 to 2760 patients; renal outcomes were a change in serum creatinine or estimated GFR and acute dialysis). 16,17,19 It is biologically plausible that statins decrease renal injury, and a protective effect of statins on the kidney has been shown in several animal studies. 8 -14 To our knowledge, our study is the largest to date to examine the association between statins and perioperative AKI.…”

Section: Discussionmentioning

confidence: 99%

“…Some observational studies have shown that statins are associated with less AKI, whereas others have not. [15][16][17][18][19][20][21] Their potential benefit in the perioperative setting has also been shown in some small randomized controlled trials where administration of statins preopera-tively improved cardiovascular outcomes. 22,23 To examine the issue further and to inform the conduct of definitive randomized controlled trials, we studied all older patients who underwent major elective surgery in Ontario, the largest province in Canada, over a 14-year period.…”

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confidence: 90%

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

Molnar

Coca

Devereaux

et al. 2011

Journal of the American Society of Nephrology

105

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Statins abrogate ischemic renal injury in animal studies but whether they are renoprotective in humans is unknown. We conducted a population-based retrospective cohort study that included 213,347 older patients who underwent major elective surgery in the province of Ontario, Canada from 1995 to 2008. During the first 14 postoperative days, 1.9% (4020 patients), developed acute kidney injury and 0.5% (1173 patients), required acute dialysis. The 30-day mortality rate was 2.8% (5974 patients). Prior to surgery, 32% of patients were taking a statin. After statistical adjustment for patient and surgical characteristics, statin use associated with 16% lower odds of acute kidney injury (OR, 0.84; 95% CI, 0.79 to 0.90), 17% lower odds of acute dialysis (OR, 0.83; 95% CI, 0.72 to 0.95), and 21% lower odds of mortality (OR, 0.79; 95% CI, 0.74 to 0.85). Propensity score matching produced similar results. These data suggest that statins may protect against renal complications after major elective surgery and reduce perioperative mortality.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 90%

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

Molnar

Coca

Devereaux

et al. 2011

Journal of the American Society of Nephrology

105

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“…Some retrospective data have suggested that the perioperative use of hepatic hydroxymethyl glutaryl-CoA reductase inhibitors (statins) reduce the risk of AKI after cardiac surgery (228,229); however, this may be caused by a healthy user bias (230), because a more rigorous, propensity matched analysis (231) failed to reveal a benefit for this class of drugs. A recent large, prospective RCT of rosuvastatin in sepsisassociated acute respiratory distress syndrome revealed a significant increase in the incidence of kidney failure (232).…”

Section: Current and Future Pharmacologic Strategiesmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

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240

185

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Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

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“…Overall statin therapy was associated with 43% and 46% reductions in the risk of death or requirement for hemodialysis, respectively (P,0.001 for both). 28 Conversely, a substantial amount of published data has challenged the true efficacy of statins in preventing renal injury postcardiac surgery. Prowle et al 29 randomized 100 patients undergoing cardiac surgery to atorvastatin 40 mg daily or placebo, with a follow-up of 30 months.…”

Section: Patients Undergoing Cardiac Surgerymentioning

confidence: 99%

The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in renal disease

Gomez¹,

Mihos²,

Pineda³

et al. 2014

IJNRD

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Abstract:It is well known that statins exert their main effect by inhibiting cholesterol synthesis through the inhibition of the 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme. The pleiotropic effects of statins, which are independent of their inhibition of cholesterol synthesis, have explained many of the beneficial effects of these drugs in a variety of disorders such as malignancies, infection, and sepsis, as well as in cardiovascular and rheumatologic disorders. However, the role of these drugs in renal disorders remains controversial. In the present review, we examine the most recent findings involving statins and renal disease among different clinical scenarios, including chronic kidney disease, contrast-induced nephropathy, renal injury after coronary artery bypass surgery, and renal transplant patients.

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Preoperative Statin Administration Is Associated With Lower Mortality and Decreased Need for Postoperative Hemodialysis in Patients Undergoing Coronary Artery Bypass Graft Surgery

Cited by 59 publications

References 27 publications

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

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

AKI Associated with Cardiac Surgery

The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in renal disease

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