Statins in the Prevention of Contrast-Induced Nephropathy
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Coronary angiography and percutaneous coronary interventions are common procedures that utilize iodinated contrast medium to visualize the coronary arterial tree and treat stable and unstable ischemic heart syndromes. Exposure to contrast agents can cause acute and persistent worsening of renal function leading to increased morbidity and mortality. Certain patient characteristics such as age, presence of diabetes, congestive heart failure, chronic kidney disease, hemodynamic instability on presentation, and type and volume of contrast used can increase the risk of developing contrast-induced nephropathy (CIN) and its subsequent complications. Despite the lack of a universal definition, CIN is typically defined as an increase in serum creatinine ≥0.5 mg/dL or 25 % above baseline 48 to 72 h after contrast exposure. Previous research has shown the benefits of adequate intravenous hydration with iso-osmolar crystalloids and the importance of limiting the amount of low-osmolar and iso-osmolar contrast used to prevent the development of CIN. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have anti-inflammatory and anti-apoptotic properties with few side effects, making it an attractive therapeutic option for prevention of CIN. A number of trials have examined the benefit of different types of statins, high-dose versus low-dose statins, loading versus chronic dosing of statins, in various clinical presentations including acute coronary syndromes and elective procedures, and in those with associated comorbidities such as anemia and chronic kidney disease. In this review, we will summarize recent data regarding statin therapy for prevention of contrast-induced nephropathy.
KeywordsContrast-induced nephropathy Prevention Statins
This investigation was supported by grant UL1TR000457 of the Clinical and Translational Science Center at Weill Cornell Medical College.
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Conflict of Interest
Dr. Anthony C. Chyou, Dr. Anay Thodge, and Dr. Rajesh V. Swaminathan each declare no potential conflicts of interest.
Dr. Dmitriy N. Feldman is a section editor for Current Treatment Options in Cardiovascular Medicine.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
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- 8.Patti G, Ricottini E, Nusca A, Colonna G, Pasceri V, D’Ambrosio A, et al. Short-term, high-dose atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the ARMYDA-CIN [atorvastatin for reduction of myocardial damage during angioplasty-contrast-induced nephropathy] trial.). Am J Cardiol. 2011;108:1–7.CrossRefPubMedGoogle Scholar
- 9.••Han Y, Zhu G, Han L, Hou F, Huang W, Liu H, et al. Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease. J Am Coll Cardiol. 2014;63:62–70. This study demonstrated that short-term low-dose rosuvastatin significantly reduced risk of CIN in patients with diabetes and stage 2 CKD undergoing coronary or peripheral angiography/interventions as compared to placebo.CrossRefPubMedGoogle Scholar
- 10.•Leoncini M, Toso A, Maioli M, Tropeano F, Villani S, Bellandi F. Early high-dose rosuvastatin for contrast-induced nephropathy prevention in acute coronary syndrome: results from the PRATO-ACS study (protective effect of rosuvastatin and antiplatelet therapy on contrast-induced acute kidney injury and myocardial damage in patients with acute coronary syndrome). J Am Coll Cardiol. 2014;63:71–9. The PRATO-ACS study showed that in statin-naïve patients presenting in ACS undergoing coronary angiography/intervention, a short course of high-dose rosuvastastin decreased the incidence of CIN and lower rate of death or nonfatal myocardial infarction at 6 month.CrossRefPubMedGoogle Scholar
- 26.••Gandhi S, Mosleh W, Abdel-Qadir H, Farkouh ME. Statins and contrast-induced acute kidney injury with coronary angiography. Am J Med. 2014;127:987–1000. The largest and most updated meta-analysis of 15 randomized controlled trials showed that short-term statin exposure reduced the risk of CIN as compared to placebo and persisted in the group presenting in acute coronary syndromes with high-dose group but not in the low-dose group. Subgroup analyses also conferred benefit in patients with diabetes, chronic kidney disease, congestive heart failure, and those receiving >140 mL of contrast medium.CrossRefPubMedGoogle Scholar
- 27.••Liu Y, Liu YH, Tan N, Chen JY, Zhou YL, Li LW, et al. Comparision of the efficacy of rosuvastatin versus atorvastatin in preventing contrast induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention. PLoS One. 2014;9:e111124. The first head-to-head trial comparing short-term pretreatment with rosuvastatin 10 mg to atorvastatin 20 mg in statin-naïve patients with CKD undergoing elective PCI and demonstrated similar efficacies in preventing CIN and longer term of all-cause mortality and major adverse cardiovascular events.CrossRefPubMedCentralPubMedGoogle Scholar
- 28.Piorkowski M, Fischer S, Stellbaum C, Jaster M, Martus P, Morguet AJ, et al. Treatment with ezetimibe plus low-dose atorvastatin compared with higher-dose atorvastatin alone: is sufficient cholesterol-lowering enough to inhibit platelets? J Am Coll Cardiol. 2007;49:1035–42.CrossRefPubMedGoogle Scholar
- 30.Xinwei J, Xianghua F, Jing Z, Xinshun G, Ling X, Weize F, et al. 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;104:519–24.CrossRefPubMedGoogle Scholar
- 33.Li W, Fu X, Wang Y, Li X, Yang Z, Wang X, et al. Beneficial effects of high-dose atorvastatin pretreatment on renal function in patients with acute ST-segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention. Cardiology. 2012;122:195–202.CrossRefPubMedGoogle Scholar
- 34.Jo S-H, Hahn J-Y, Lee SY, Kim HJ, Song YB, Choi JH, Choi SH, Lee SH, Gwon HC. High Dose Atorvastatin Pretreatment for Preventing Contrast-Induced Nephropathy in Patients Receiving Primary Percutaneous Coronary Intervention. J Cardiovasc Med. 2014. E-published ahead of print.Google Scholar