Abstract
Background
Contrast-induced nephropathy (CIN) is a rare but serious complication following contrast-based
procedures. Statins have been postulated to prevent CIN via various mechanisms. However,
the outcomes following statin administration to prevent CIN have been inconsistent.
Methods
A meta-analysis of published randomized clinical trials was performed to determine
if short-term administration of high-dose statin is superior to conventional-dose
statin or placebo among patients undergoing catheterization and interventional procedures
in preventing CIN.
Results
Data were combined across 8 published clinical trials in which 1423 patients were
identified. Pooled analyses showed that short-term high-dose statin treatment can
decrease the occurrence of CIN (risk ratio 0.51, 95% confidence interval [CI], 0.34-0.77;
P = 0.001) and 48-hour serum creatinine level (standardized mean difference [SMD] –0.07
mg/dL; 95% CI, –0.11 to –0.04 mg/dL; P < 0.00001). However, subgroup analysis showed that statin pretreatment cannot decrease
the occurrence of CIN in patients with preexisting renal impairment (RR 0.90; 95%
CI, 0.49-1.65; P = 0.73). No evidence of publication bias was detected.
Conclusions
This meta-analysis supports the effectiveness of short-term high-dose statin pretreatment
for both decreasing the level of serum creatinine and reducing the rate of CIN in
patients undergoing diagnostic and interventional procedures requiring contrast media.
However, prospective clinical trials will be needed to draw a definitive conclusion
in this area.
Résumé
Introduction
La néphropathie induite par les produits de contraste (NIC) est une complication rare,
mais sérieuse, à la suite d'examens de contraste. Les statines sont présumées prévenir
la NIC par divers mécanismes. Cependant, les résultats suivant l'administration de
statines pour prévenir la NIC ont été inconsistants.
Méthodes
Une métaanalyse d'essais cliniques aléatoires publiés a été faite pour déterminer
si l'administration à court terme de doses élevées de statines est supérieure à la
dose usuelle de statines ou au placebo chez les patients subissant une cathétérisation
et des procédures interventionnelles en prévention de la NIC.
Résultats
Les données ont été combinées à partir de 8 essais cliniques publiés parmi lesquels
1 423 patients ont été identifiés. Les analyses groupées ont montré qu'un traitement
à court terme à doses élevées de statines peut diminuer l'occurrence de la NIC (risque
relatif [RR] de 0,51, intervalle de confiance [IC] de 95 %, 0,34-0,77; P = 0,001) et le niveau de créatinine sérique après 48 heures (déviation standard moyenne
[DMS]) –0,07 mg/dl; IC de 95 %, –0,11 à –0,04 mg/dl; P < 0,00001). Cependant, l'analyse par sous-groupe a montré qu'un prétraitement par
statines ne peut pas diminuer l'occurrence de la NIC chez les patients avec une insuffisance
rénale préexistante (RR de 0,90; IC de 95 %, 0,49-1,65; P = 0,73). Aucune preuve de biais de publication n'a été trouvée.
Conclusions
Cette métaanalyse appuie l'efficacité d'un prétraitement à court terme à doses élevées
de statines tant pour la diminution du niveau de créatinine sérique que pour la réduction
du taux de NIC chez les patients subissant un diagnostic et des procédures interventionnelles
nécessitant un produit de contraste. Cependant, des essais cliniques prospectifs seront
nécessaires pour tirer une conclusion définitive dans ce domaine.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Contrast-induced acute kidney injury.Circulation. 2010; 122: 2451-2455
- Contrast-induced nephropathy in patients undergoing computed tomography (CONNECT): a clinical problem in daily practice?.Acta Radiol. 2010; 51: 741-750
- Contrast-induced nephropathy and its prevention: what do we really know from evidence-based findings?.J Nephrol. 2009; 22: 333-351
- Epidemiology and prognostic implications of contrast-induced nephropathy.Am J Cardiol. 2006; 98: 5K-13K
- Statin therapy reduces contrast-induced nephropathy: an analysis of contemporary percutaneous interventions.Am J Med. 2005; 118: 843-849
- The potential role of statins in contrast nephropathy.Clin Nephrol. 2004; 62: 273-278
- Efficacy of short-term high-dose atorvastatin for prevention of contrast-induced nephropathy in patients undergoing coronary angiography.Angiology. 2010; 61: 711-714
- Prevention of contrast-induced impairment of renal function by short-term or long-term statin therapy in patients undergoing elective coronary angiography.Blood Coagul Fibrinolysis. 2010; 21: 750-757
- Comparison of usefulness of simvastatin 20 mg versus 80 mg in preventing contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention.Am J Cardiol. 2009; 104: 519-524
- Usefulness of atorvastatin (80 mg) in prevention of contrast-induced nephropathy in patients with chronic renal disease.Am J Cardiol. 2010; 105: 288-292
- Prevention of radiocontrast medium-induced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial: a randomized controlled study.Am Heart J. 2008; 155: 499.e1-499.e8
- A review of high-dose statin therapy: targeting cholesterol and inflammation in atherosclerosis.Eur Heart J. 2007; 28: 664-672
- High-dose statin therapy: benefits and safety in aggressive lipid lowering.J Fam Pract. 2008; 57: S29-S36
- Evidence-based management of patients undergoing PCI: contrast-induced acute kidney injury.Catheter Cardiovasc Interv. 2010; 75: S15-S20
- Efficacy of high dose atorvastatin on preventing contrast induced nephropathy in patients underwent coronary angiography [in Chinese].Zhonghua Xin Xue Guan Bing Za Zhi. 2009; 37: 394-396
- [Clinical research of atorvastatin on preventing contrast-induced nephropathy in patients underwent coronary artery CTA] [in Chinese].Clin Med Eng. 2010; 17: 48-50
- Prevention of contrast-induced nephropathy using high-dose atorvastatin in patients with coronary heart disease undergoing elective percutaneous coronary intervention [in Chinese].Milit Med J South China. 2010; 24: 448-451
- The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus.J Clin Epidemiol. 1998; 51: 1235-1241
- Assessing the quality of reports of randomized clinical trials: is blinding necessary?.Control Clin Trials. 1996; 17: 1-12
- Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention.Circulation. 2002; 105: 2259-2264
- Statin effects beyond lipid lowering: are they clinically relevant?.Eur Heart J. 2003; 24: 225-248
- The lipid and non-lipid effects of statins.Pharmacol Ther. 2003; 99: 95-112
- Radiographic contrast media-induced tubular injury: evaluation of oxidant stress and plasma membrane integrity.Kidney Int. 2003; 64: 128-139
- Postischemic acute renal failure is reduced by short-term statin treatment in a rat model.J Am Soc Nephrol. 2002; 13: 2288-2298
- Prevention of contrast-induced nephropathy by chronic pravastatin treatment in patients with cardiovascular disease and renal insufficiency.J Cardiol. 2009; 54: 192-198
- Statins for the prevention of contrast-induced nephropathy: a systematic review and meta-analysis.Am J Nephrol. 2011; 33: 344-351
- Predictors for contrast media-induced nephropathy and long-term survival: prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial.Can J Cardiol. 2008; 24: 845-850
Article info
Publication history
Published online: September 26, 2011
Accepted:
May 13,
2011
Received:
March 26,
2011
Footnotes
See page 857 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
