Beneficial effect of statin on preventing contrast-induced acute kidney injury in patients with renal insufficiency A meta-analysis

초록

Background: Renal insufficiency is an important predictor of contrast-induced acute kidney injury (CI-AKI). We performed a meta-analysis to examine the effects of short-term statin therapy on the incidence of CI-AKI, particularly in patients with renal insufficiency. Methods: A systematic search was conducted to retrieve randomized controlled trials (RCTs) that investigated the impact of statin pretreatment before administration of contrast media on the development of CI-AKI in patients with mild to moderate renal insufficiency. The primary outcome was development of CI-AKI. The secondary outcome was the incidence ofacute kidney injury requiring hemodialysis. Results: Data analysis from 8 RCTs, which included a total of 2313 subjects in the statin-treated group and 2322 in the control group, showed that statin pretreatment was associated with significant reduction of the risk of CI-AKI (relative risk [RR] = 0.59; 95% confidential interval [CI] 0.44–0.79; P = .0003, I2 = 0%). A beneficial effect of statin on preventing CI-AKI was consistent, regardless of the dose of statin and use of N-acetylcysteine. In subgroup analysis based on baseline estimated glomerular filtration rate (eGFR), patients with baseline eGFR <60 mL/min/1.73 m2 (RR = 0.63; 95% CI 0.41–0.98; P = .04, I2 = 0%) and 30 < eGFR < 90 mL/min/1.73 m2 (RR = 0.56; 95% CI 0.39–0.82; P = .003, I2 = 0%) showed significant reduction of risk of CI-AKI. Conclusion: Statin pretreatment is effective at preventing CI-AKI and should be considered in patients with preexisting renal insufficiency.

키워드