Brief, high-dose statin reduces contrast-induced kidney injuries

Use of short-term, high-dose atorvastatin may help patients avoid contrast-induced kidney injury, according to a meta-analysis published in the February issue of The Journal of Clinical Pharmacology.

Researchers explored the outcomes of 14 Chinese studies that reported on high- and low-dose atorvastatin (Lipitor, Pfizer) use and acute kidney injury outcomes following PCI or coronary angiography. Twelve trials administered atorvastatin to patients within a 72-hour window before PCI or coronary angiography and two trials gave patients the statin for seven days before contrast.

Hongjiang Wu, PhD, from the department of cardiovascular surgery at the Shenyang Northern Hospital in Shenyang, China, and colleagues found that among patients given high doses of atorvastatin, serum creatinine decreased by of 0.1 mg/dl. In the two trials with reported serum cystatin C levels, the marker decreased by 0.21 mg/L with high doses of atorvastatin. Serum beta2-microglobullin levels decreased by 0.27 mg/L. Serum hypersensitive C reactive protein levels decreased by 2.25 mg/L with the high dose.

Risk for developing contrast-induced nephropathy was less than half in patients given high doses as opposed to low doses of atorvastatin (risk ratio: 0.41).

Looking at the outcomes of PCI against coronary angiography, patients undergoing PCI had a 55 percent reduction in the incidence of contrast-induced nephropathy when given high doses of atorvastatin. Patients given high doses of atorvastatin undergoing coronary angiography, on the other hand, did not have a statistically significant reduction.

Wu et al did not find a decrease in incidence of contrast-induced nephropathy in patients with chronic kidney disease.

“Short-term high-dose atorvastatin treatment appears to achieve greater benefits in preventing acute kidney injury among patients undergoing CAG [coronary angiography] and PCI requiring contrast media, particularly in those patients who are undergoing PCI,” they wrote. However, Wu et al noted that the quality of the trials available on the subject was low.

They called for more well-designed randomized clinical trials to assess dose and outcomes and suggested long-term clinical outcomes studies may also improve understanding of the utility and outcomes of a high-dose atorvastatin method to prevent acute kidney injury.