Statins for primary prevention of cardiovascular disease and the risk of acute kidney injury

Abstract

PurposeTo investigate the risk of acute kidney injury (AKI) in subjects initiating statin therapy for primary prevention of cardiovascular disease (CVD).MethodsA nationwide cohort study using French hospital discharge and claims databases was performed, studying subjects from the general population aged 40 to 75 years in 2009, with no history of CVD and no lipid‐lowering drugs during the preceding 3‐year period, followed for up to 7 years. Exposure to statins (type, dose, and time since first use) and to other drugs for CVD risk was assessed. The primary outcome was hospital admission for AKI.ResultsThe cohort included 8 236 279 subjects, 818 432 of whom initiated a statin for primary prevention. During 598 487 785 person‐months exposed to statins, 700 events were observed, corresponding to an incidence of AKI of 4.59 per 10 000 person‐years (7.01 in men, 3.01 in women). AKI mainly occurred in the context of organ failure, sepsis, and genitourinary disease. A 19% increased rate of AKI (hazard ratio = 1.19, 95%CI: 1.08‐1.31) was observed in men exposed to statins, whereas no increase in the overall risk of AKI was observed in women. However, exposure to high‐potency statins was associated with a 72% to 116% increased risk in both genders and a dose‐effect relationship observed for rosuvastatin and atorvastatin. No temporal pattern of occurrence nor interaction with drugs for CVD risk was observed.ConclusionsAlthough the overall risk of AKI appears moderately increased, more attention should be paid to renal function in subjects taking statins for primary prevention both in clinical practice and from a research viewpoint.

Paediatric outpatient prescriptions in France between 2010 and 2019: A nationwide population-based study

“…Second, as in many other studies, dispensed prescriptions were used as a proxy for drug prescription [ 14 , 15 ]. Third, prescribing and reimbursement of drugs also available as OTCs appears to represent an important share of the total POP [22] , contrary to most countries with advanced economies [ 22 , 29 , 30 ]. For instance in our study, amongst the 14 most-prescribed paediatric outpatient drugs, 5 were drugs also available as OTCs (helicidin, metopimazine, phloroglucinol, racecadotril, tixocortol).…”

“…We conducted a national administrative database analysis and followed the RECORD-PE guidelines to report the results [27] . The French National Health Data System (Système national de données de santé [SNDS]) covers 98•8% of the French population and includes reimbursement data for ambulatory care (the health insurance claims database, or Datamart de Consommation Inter-Régime [DCIR]) for all children covered by the Universal Public Health Insurance in France [29] , [29] , [30] . Every user (or parent user for children) of the French Public Health Insurance is informed of his/her opposition right regarding the use of their data for research purposes.…”

Hospitalization for adverse events under abiraterone or enzalutamide exposure in real‐world setting: A French population‐based study on prostate cancer patients

“…40 A French population-based study also suggested that the risk of AKI is moderately higher among men exposed to statins in primary prevention. 42 Dyslipidaemia drugs were used for 35.7% of our sub-population without differences between groups, and they did not influence the AKI IRR estimation (data not shown). Cardiac or renal aetiologies related to AKI were unlikely, as a history of heart failure and renal disease are criteria for non-inclusion in the sub-population.…”

Influence of statin‐potency on the risk of kidney disease – A nationwide cohort study using laboratory data

“…37 Our findings concur with prior studies, although such comparisons are imperfect given differing definitions of outcomes and exposure. 4,5,24,38,39 Indeed, most observational studies assessed the association between statin-use and acute kidney disease in hospital discharge records. 5 Dormuth found a 34% increase in hospitalization rate for AKI within 120 days of initiating high-versus low-potency statins only in patients without history of kidney disease.…”