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Published on: February 2, 2021
Effect of statins on post-contrast acute kidney injury: a multicenter retrospective observational study
Maoning Lin1,2, Tian Xu1,2, Wenjuan Zhang3
1Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China.
Insights
Preoperative statins therapy significantly reduces the risk of post-contrast acute kidney injury (PC-AKI) after coronary angiography and percutaneous coronary intervention. This protective effect is independent of lipid-lowering or anti-inflammatory mechanisms.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Post-contrast acute kidney injury (PC-AKI) is a serious complication following coronary angiography (CAG) and percutaneous coronary intervention (PCI).
- The precise role and mechanism of statins in preventing PC-AKI remain incompletely understood.
Purpose of the Study:
- To investigate the protective effect of preoperative statins therapy on PC-AKI.
- To explore the underlying mechanisms, including lipid-lowering and anti-inflammatory pathways.
Main Methods:
- A multicenter retrospective observational study involving 4386 patients undergoing CAG or PCI.
- Analysis of serum creatinine levels and multivariate logistic regression to assess the association between statin use and PC-AKI.
- Path analysis was employed to examine potential mediating factors.
Main Results:
- Preoperative statins therapy was associated with a significantly lower incidence of PC-AKI (OR: 0.575, P < 0.001).
- The protective effect was direct and not mediated by lipid-lowering or anti-inflammatory effects.
- Low-density lipoprotein cholesterol (LDL-C) to C-reactive protein (CRP) pathway showed a minor mediating role (P = 0.007).
Conclusions:
- Preoperative statins therapy is an independent protective factor against PC-AKI.
- The benefits of statins in preventing PC-AKI are not primarily due to their effects on lipids or inflammation.
- Statins represent a potential strategy for mitigating PC-AKI risk in patients undergoing cardiovascular procedures.
Background:
Post-contrast acute kidney injury (PC-AKI) is a severe complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Currently, the effect of statins on PC-AKI and its mechanism remains unclear.
Methods:
This multicenter retrospective observational study included 4386 patients who underwent CAG or PCI from December 2006 to December 2019 in Sir Run Run Shaw Hospital and its medical consortium hospitals. Serum creatinine pre- or post-procedure within 72 h after PCI was recorded. Multivariate logical regression was used to explore whether preoperative use of statins was protective from PC-AKI. The path analysis model was then utilized to look for the mediation factors of statins.
Results:
Four thousand three hundred eighty-six patients were enrolled totally. The median age of the study population was 68 years old, 17.9% with PC-AKI, and 83.3% on preoperative statins therapy. The incidence of PC-AKI was significantly lower in group of patients on statins therapy. Multivariate regression indicated that preoperative statins therapy was significantly associated with lower percentage of elevated creatinine (β: -0.118, P < 0.001) and less PC-AKI (OR: 0.575, P < 0.001). In the preoperative statins therapy group, no statistically significant difference was detected between the atorvastatin and rosuvastatin groups (OR: 1.052, P = 0.558). Pathway model analysis indicated a direct protective effect of preoperative statins therapy on PC-AKI (P < 0.001), but not through its lipid-lowering effect (P = 0.277) nor anti-inflammatory effect (P = 0.596). Furthermore, it was found that "low-density lipoprotein cholesterol (LDL-C)→C-reactive protein (CRP)" mediated the relationship between preoperative statins therapy and PC-AKI (P = 0.007). However, this only explained less than 1% of the preoperative protective effects of statins on PC-AKI.
Conclusion:
Preoperative statins therapy is an independent protective factor of PC-AKI, regardless of its type. This protective effect is not achieved by lipid-lowering effect or anti-inflammatory effect. These findings underscore the potential use of statins in preventing PC-AKI among those at risk.
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