Statins and contrast-induced acute kidney injury with coronary angiography: systematic review and meta-analysis.
Am J Med. 2014 May 19;
Authors: Gandhi S, Mosleh W, Abdel-Qadir H, Farkouh ME
BACKGROUND: Contrast-induced acute kidney injury is an adverse outcome resulting from radiocontrast medium exposure during coronary angiography and percutaneous coronary intervention.
METHODS: A systematic search was conducted to retrieve studies that investigated the impact of statin exposure prior to coronary angiography and/or percutaneous coronary intervention on the development of contrast-induced acute kidney injury. The primary outcomes was the development of contrast-induced acute kidney injury. We separately analyzed statin/placebo comparisons and high/low dose statin comparisons.
RESULTS: 15 randomized controlled trials met inclusion criteria: 11 studies with statin naïve subjects, two studies with chronic statin users, and two studies with unspecified prior statin exposure. Statin exposure reduced the risk of contrast-induced acute kidney injury relative to placebo (RR 0.63,p=0.01) with a non-significant reduction in the need for hemodialysis (RR 0.25,p=0.08). This benefit was also observed in high-dose vs. low-dose statin trials (RR 0.46,p=0.004), in statin-naïve patients (RR 0.53, p<0.0001) and with all studied statins. Higher statin exposure reduced contrast-induced acute kidney injury in patients with acute coronary syndromes compared with placebo or low-dose statins (RR 0.49,p<0.00001), with no significant benefit among patients undergoing elective procedures (RR 0.86,p=0.50). Subgroup analyses confirmed the benefit of statins in patients with diabetes, chronic kidney disease, congestive heart failure, and those receiving >140 mL of contrast dye.
CONCLUSION: Statin therapy is effective at reducing the risk of contrast-induced acute kidney injury. It should thus be considered, at least on a short-term basis, for patients at increased risk of this complication.
PMID: 24852935 [PubMed - as supplied by publisher]