Statins for prevention of contrast‐induced nephropathy in patients undergoing non‐emergent percutaneous coronary intervention

Kandula, Praveen; Shah, Ravish; Singh, Nilanchali; Markwell, Stephen; Bhensdadia, Nishant; Navaneethan, Sankar D.

doi:10.1111/j.1440-1797.2009.01204.x

Cited by 35 publications

(34 citation statements)

References 32 publications

(37 reference statements)

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“…Although it remains uncertain whether statins lower the risk of contrast-induced AKI or are associated with AKI when used in high doses, they have been consistently shown to lower major adverse cardiovascular events in most populations (37)(38)(39)(40)(41)(42)(43)(44)(45). To our knowledge, there are no published reports of AKI associated with b-blocker use.…”

Section: Discussionmentioning

confidence: 66%

Contrast-Associated AKI and Use of Cardiovascular Medications after Acute Coronary Syndrome

Leung¹,

Pannu

Tan

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives AKI after coronary angiography is associated with poor long-term outcomes. The relationship between contrast-associated AKI and subsequent use of prognosis-modifying cardiovascular medications is unknown.Design, setting, participants, & measurements A cohort study of 5911 participants 66 years of age or older with acute coronary syndrome who received a coronary angiogram in Alberta, Canada was performed between November 1, 2002, and November 30, 2008. AKI was identified according to Kidney Disease Improving Global Outcomes AKI criteria.Results In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2-3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65; 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34; 95% confidence interval, 0.23 to 0.48, respectively). Subsequent statin and b-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2-3 AKI (adjusted odds ratio, 0.44; 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46; 95% confidence interval, 0.31 to 0.66, respectively). These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria; 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI.Conclusions Strategies to optimize the use of cardiac medications in people with AKI after coronary angiography might improve care.

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Section: Discussionmentioning

confidence: 66%

Contrast-Associated AKI and Use of Cardiovascular Medications after Acute Coronary Syndrome

Leung¹,

Pannu

Tan

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Accumulating clinical evidence suggests that atorvastatin has a preventive effect against CIN, and can reduce the incidence of dialysis and long-term mortality in patients with CIN (7,8,11,21). However, another previous study has revealed that statin use prior to percutaneous coronary intervention is not associated with a reduction in CIN (22). Therefore, the present study aimed to investigate the effects and potential underlying molecular mechanisms of atorvastatin on iodinated contrast agent-induced cytotoxicity.…”

Section: Discussionmentioning

confidence: 95%

Atorvastatin alleviates iodinated contrast media-induced cytotoxicity in human proximal renal tubular epithelial cells

Liu

Lei

Duan

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Contrast media (CM)-induced nephropathy (CIN) is a serious complication of intravascularly applied radiocontrast media. At present, no drugs have been approved for the prevention of CIN. The present study aimed to explore the effects and potential mechanisms of atorvastatin on iodinated CM-induced cytotoxicity in the human proximal renal tubular epithelial cells. The cytotoxic effect of iohexol (50, 100 and 200 mg I/ ml) and the protective effect of atorvastatin pretreatment (1, 20 and 40 µM) were assessed. The cytotoxicity of iohexol was evaluated via the MTT cell viability and lactate dehydrogenase assays. The amount of apoptotic cells was determined by flow cytometry. Morphological changes in HK-2 cells were observed via transmission electron microscopy. The mRNA expression of NOX4 and p22phox was measured through reverse transcription-quantitative polymerase chain reaction analysis. The cytotoxicity was induced by iohexol in HK-2 cells. Atorvastatin was identified to significantly alleviate the suppression of cell viability induced by iohexol. Notably, 40 µM atorvastatin also significantly reduced the mRNA expression of intracellular NOX4 and p22phox, and the percentage of apoptotic cells. Furthermore, morphological changes characteristic of injured cells were alleviated by atorvastatin pretreatment. These results suggest that atorvastatin exhibits a protective effect on HK-2 cells against iohexol-induced cytotoxicity through the downregulation of NOX4 and p22phox. Thus, atorvastatin is a potential therapeutic agent for the prevention of CIN and required further study.

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“…Given the potential role of oxidative stress in the pathophysiology of RCIN, statins might reduce contrast media nephrotoxicity by removing free radicals [133][134][135] . The possibility that statins might be beneficial in reducing the incidence of contrast-induced acute renal failure has been examined in several observational studies [136][137][138] and RCTs [139][140][141][142] . The earliest study by Attallah et al [130] reviewed a database of 1002 patients with renal insufficiency undergoing coronary angiography.…”

Section: Statins For Rcin Preventionmentioning

confidence: 99%

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Hung¹,

Lin²,

Hung³

et al. 2012

WJC

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Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short-and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.

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Statins for prevention of contrast‐induced nephropathy in patients undergoing non‐emergent percutaneous coronary intervention

Abstract: Statin use before non-emergent PCI is not associated with reduction in CIN. Further randomized controlled trials based on proper risk adjustment for development of CIN are needed.

Cited by 35 publications

References 32 publications

Contrast-Associated AKI and Use of Cardiovascular Medications after Acute Coronary Syndrome

Contrast-Associated AKI and Use of Cardiovascular Medications after Acute Coronary Syndrome

Atorvastatin alleviates iodinated contrast media-induced cytotoxicity in human proximal renal tubular epithelial cells

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

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