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The role of statins in the prevention of contrast induced nephropathy: a meta-analysis of 8 randomized trials

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Abstract

Contrast induced nephropathy (CIN) is a common complication of coronary angiography/angioplasty. Prevention is the key to reduce the incidence of CIN and it begins with appropriate pre-procedural management. Statins have been shown to possess pleiotropic effects (anti-oxidant, anti-inflammatory and anti-thrombotic properties) and their effects on CIN were assessed in several studies with conflicting results. Aim of this meta-analysis is to evaluate the efficacy of short-term statins for the prevention of CIN in patients undergoing coronary angiography/percutaneous interventions. We performed formal searches of PubMed, EMBASE, Cochrane central register of controlled trials and major international scientific session abstracts from January 1990 to January 2014 of trials which compares short-term statins versus Placebo for the prevention of CIN in patients undergoing coronary angiography/angioplasty. Data regarding study design, statin dose, inclusion/exclusion criteria, number of patients, and clinical outcome was extracted by 2 investigators. Eight trials were included, with a total of 4734 patients. CIN occurred in 79/2,358 patients (3.3 %) treated with statins versus 153/2,376 patients (6.4 %) of the placebo group [OR 95 % CI 0.50 (0.38–0.66), p < 0.00001; p het = 0.39]. Benefits were both observed with high-dose short-term statins [OR 95 % CI 0.44 (0.30–0.65), p < 0.0001; p het = 0.16] and low-dose statins, [OR 95 % CI 0.58 (0.39–0.88), p = 0.010; p het = 0.90]. By meta-regression analysis, no significant relationship was observed between benefits from statin therapy and patient’s risk profile (p = 0.26), LDL cholesterol (p = 0.4), contrast volume (p = 0.94) or diabetes rate (p = 0.38). This meta-analysis showed that among patients undergoing coronary angiography/percutaneous intervention the use of short-term statins reduces the incidence of CIN, and therefore is highly recommended even in patients with low LDL-cholesterol levels.

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References

  1. McCullough PA (2008) Contrast-induced acute kidney injury. J Am Coll Cardiol 51:1419–1428

    Article  PubMed  Google Scholar 

  2. James MT, Gali WA et al (2010) Acute kidney injury following coronary angiography is associated with a long-term decline in kidney funcion. Kidney Int 78:803–809

    Article  PubMed  Google Scholar 

  3. Nash K, Hafeez A, Hou S et al (2002) Hosputal acquired renal insufficiency. Am J Kidney Dis 39:930–936

    Article  PubMed  Google Scholar 

  4. McCullough PA (2008) Contrast-induced acute kidney injury. J Am Coll Cardiol 51:1419–1428

    Article  PubMed  Google Scholar 

  5. Maeder M, Klein M, Fehr T et al (2004) Contrast nephropathy: review focusing on prevention. J Am Coll Cardiol 44:1763–1771

    Article  PubMed  Google Scholar 

  6. De Luca G, Bellandi F, Huber K et al (2011) Early glycoprotein IIb-IIIa inhibitors in primary angioplasty-abciximab long-term results (EGYPT-ALT) cooperation: individual patient’s data meta-analysis. J Thromb Haemost 9:2361–2370

    Article  Google Scholar 

  7. De Luca G, Cassetti E, Verdoia M et al (2009) Bivalirudin as compared to unfractionated heparin among patients undergoing coronary angioplasty: a meta-analyis of randomised trials. Thromb Haemost 102(3):428–436

    PubMed  Google Scholar 

  8. Di Lorenzo E, Sauro R, Varricchio A et al (2009) Benefits of drug-eluting stents as compared to bare metal stent in ST-segment elevation myocardial infarction: 4-year results of the PaclitAxel or Sirolimus-Eluting stent vs bare metal stent in primary angiOplasty (PASEO) randomized trial. Am Heart J 158(4):e43–e50

    Article  PubMed  Google Scholar 

  9. Navarese EP, Kubica J, Castriota F et al (2011) Safety and efficacy of biodegradable vs. durable polymer drug-eluting stents: evidence from a meta-analysis of randomised trials. EuroIntervention 7:985–994

    Article  PubMed  Google Scholar 

  10. De Luca G, Dirksen MT, Spaulding C et al (2012) Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation. Drug-eluting vs. bare-metal stents in primary angioplasty: a pooled patient-level meta-analysis of randomized trials. Arch Intern Med 172:611–621

    Article  PubMed  Google Scholar 

  11. Merten GJ, Burgess WP, Gray LV et al (2004) Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 291:2328–2334

    Article  PubMed  CAS  Google Scholar 

  12. From AM, Bartholmai BJ, Williams AW et al (2008) Sodium bicarbonate is associated with an increased incidence of conrast nephropathy: a retrospective study. Clin J Am Soc Nephrol 3:10–18

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Marenzi G, Assanelli E, Marana I et al (2006) N-Acetylcysteine and contrast-induced nephropathy in primary angioplasty. NEJM 354:2773–2782

    Article  PubMed  CAS  Google Scholar 

  14. Stone GW, McCullough PA, Tumlin JA et al (2003) CONTRAST Investigators. Fenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial. JAMA 290:2284–2291

    Article  PubMed  CAS  Google Scholar 

  15. Schindler R, Stahl C, Venz S et al (2001) Removal of contrast media by different extracorporeal treatments. Nephrol Dial Transplant 16:1471–1474

    Article  PubMed  CAS  Google Scholar 

  16. Marenzi G, Marana I, Lauri G et al (2003) The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 349:1333–1340

    Article  PubMed  CAS  Google Scholar 

  17. Pannu N, Wiebe N, Tonelli M (2006) Prophylaxis strategies for contrast-induced nephropathy. JAMA 295:2765–2779

    Article  PubMed  CAS  Google Scholar 

  18. Barrett BJ, Parfrey PS (2006) Preventing nephropathy induced by contrast medium. NEJM 354:379–386

    Article  PubMed  CAS  Google Scholar 

  19. Ridker PM, Rifai N, Clearfield M et al (2001) Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med 344:1959–1965

    Article  PubMed  CAS  Google Scholar 

  20. Zhang BC, Li WM, Xu YW et al (2011) High-dose statin pre-treatment for the prevention of contrast induced nephropathy: a meta analysis. Can J Cardiol 27:851–858

    Article  PubMed  Google Scholar 

  21. Khanal S, Attallah N, Smith DE et al (2005) Statin therapy reduces contrast induced nephropathy : an analysis of contemporary percutaneous interventions. Am J Med 118:843–849

    Article  PubMed  CAS  Google Scholar 

  22. Attallah N, Yassine L, Musial J et al (2004) The potential role of statins in contrast nephropathy. Clin Nephrol 62:273–278

    Article  PubMed  CAS  Google Scholar 

  23. Zhao JL, Yang YJ, Zhang YH et al (2008) Effect of statins on contrast induced nephropathy in patients with acute myocardial infarction treated with primary angioplasty. Int J Cardiol 126:435–436

    Article  PubMed  Google Scholar 

  24. Yoshida S, Kamihata H, Nakamura S et al (2009) Prevention of contrast induced nephropathy by chronic pravastatin treatment in patients with cardiovascular disease and renal insufficiency. J Cardiol 54:192–198

    Article  PubMed  Google Scholar 

  25. Kandula P, Shah R, Singh N et al (2010) Statins for prevention of contrast induced nephropathy in patients undergoing non-emergent percutaneous coronary intervention. Nephrology 15:165–170

    Article  PubMed  CAS  Google Scholar 

  26. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  PubMed  CAS  Google Scholar 

  27. Biondi-Zoccai GG, Abbate A, Agostoni P et al (2003) Stenting versus surgical bypass grafting for coronary artery disease: systematic overview and meta-analysis of randomized trials. Ital Heart J 4:271–280

    PubMed  Google Scholar 

  28. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–W94

    Article  PubMed  Google Scholar 

  29. Ozhan H, Erden I, Ordu S et al (2010) Efficacy of short-term high-dose atorvastatin for prevention of contrast-induced nephropathy in patients undergoing coronary angiography. Angiology 61(7):711–714

    Article  PubMed  CAS  Google Scholar 

  30. Acikel S, Muderrisoglu H, Yldirir A et al (2010) 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 21(8):750–757

    PubMed  CAS  Google Scholar 

  31. Li W, Fu W, Wang Y et al (2012) 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 122:195–202

    Article  PubMed  CAS  Google Scholar 

  32. Jo Sang-Ho, Koo Bon-Know, Park Jin-Shik et al (2008) 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 155:499.e1–499.e8

    Article  Google Scholar 

  33. Toso A, Maioli M, Leoncini M et al (2010) Usefulness of Atorvastitin (80 mg) in prevention of contrast induced nephropathy in patients with chronic renal disease. Am J Cardiol 105:288–292

    Article  PubMed  CAS  Google Scholar 

  34. Patti G, Ricottini E, Nusca A et al (2011) Short term, high-dose Atorvastatin pre-treatment to prevent contrast induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary interventions (from the ARMYDA CIN trial). Am J Cardiol 108:1–7

    Article  PubMed  CAS  Google Scholar 

  35. Leoncini M, Toso A, Maioli M et al (2014) Early high-dose Rosuvastatin for contrast induced nephropathy prevention in acute coronary syndrome. J Am Coll Cardiol 63:71–79

    Article  PubMed  CAS  Google Scholar 

  36. Han Y, Zhu G, Han L et al (2014) Short term Rosuvastatin therapy for prevention of contrast induced acute kidney injury in patients with diabetesand chronic kidney disease. J Am Coll Cardiol 63:62–70

    Article  PubMed  CAS  Google Scholar 

  37. De Luca G, Navarese EP, Suryapranata H (2013) A meta-analytic overview of thrombectomy during primary angioplasty. Int J Cardiol 166:606–612

    Article  PubMed  Google Scholar 

  38. De Luca G, Navarese EP, Cassetti E et al (2011) Meta-analysis of randomized trials of glycoprotein IIb/IIIa inhibitors in high-risk acute coronary syndromes patients undergoing invasive strategy. Am J Cardiol 107:198–203

    Article  PubMed  Google Scholar 

  39. Navarese EP, De Luca G, Castriota F et al (2011) Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis. J Thromb Haemost 9:1902–1915

    Article  PubMed  CAS  Google Scholar 

  40. Capozzolo C, Piscione F, De Luca G et al (2001) Direct coronary stenting: effect on coronary blood flow, immediate and late clinical results. Catheter Cardiovasc Interv 53:464–473

    Article  PubMed  CAS  Google Scholar 

  41. Gueler F, Rang S, Park JK et al (2002) Post ischemic acute renal failure is reduced by short term statin treatment in a rat model. J Am Soc Nephrol 13:2288–2298

    Article  PubMed  CAS  Google Scholar 

  42. Park JK, Muller DN, Mervala EM et al (2000) Carivastatin prevents angiotensin II induced renal injury independent of blood pressure and cholesterol-lowering effects. Kidney Int 58:1420–1430

    Article  PubMed  CAS  Google Scholar 

  43. Bonetti PO, Lerman LO, Napoli C et al (2003) Statin effects beyond lipid lowering: are they clinical relevant? Eur Heart J 24:225–248

    Article  PubMed  CAS  Google Scholar 

  44. Ichiki T, Takeda K, Tokunou T et al (2001) Dowregulation of angiotensin II type 1 receptor by hydrophobic 3 –hydroxy-3methylglutaryl coenzyme A reductase inhibitors in vascular smooth muscle cells. Arterioscler Thromb Vasc Biol 21:1896–1901

    Article  PubMed  CAS  Google Scholar 

  45. Pappy R, Stavrakis S, Hennebry TA et al (2011) Effect of statin therapy on contrast induced nephropathy after coronary angiography: a meta-analysis. Int J Cardiol 15:348–353

    Article  Google Scholar 

  46. Zhang T, Shen LH, Hu LH et al (2011) Statins for the prevention of contrast induced nephropathy: a systematic review and meta-analysis. Am J Nephrol 33:344–351

    Article  PubMed  Google Scholar 

  47. Zhou Y, Yuan WJ, Zhu N et al (2011) Short term, high dose statins in the prevention of contrast induced nephropathy: a systematic review and meta-analysis. Clin Nephrol 76:475–483

    Article  PubMed  CAS  Google Scholar 

  48. Zhang BC, Li WM, Xu YW et al (2011) High-dose statin pretreatment for the prevention of contrast-induced nephropathy: a meta-analysis. Can J Cardiol. 27(6):851–858

    Article  PubMed  Google Scholar 

  49. Li Y, Liu Y, Fu L et al (2012) Efficacy of short-term high-dose statin in preventing contrast-induced nephropathy: a meta-analysis of seven randomized controlled trials. PLoS One 7(4):e34450

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  50. Lameire N, Kellum JA, for the KDIGO AKI Guideline Work Group (2013) Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2). Crit Care 17:205 (in press)

    Google Scholar 

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Acknowledgments

Prof De Luca had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of interest

The authors have no conflict of interest regarding the opinion expressed in this manuscript and did not receive Grant or financial support from industry or from any other source to prepare this review.

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Authors and Affiliations

  1. Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Corso Mazzini, 18, 28100, Novara, Italy

    Lucia Barbieri, Monica Verdoia, Alon Schaffer, Matteo Nardin, Paolo Marino & Giuseppe De Luca

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  1. Lucia Barbieri
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Correspondence to Giuseppe De Luca.

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Barbieri, L., Verdoia, M., Schaffer, A. et al. The role of statins in the prevention of contrast induced nephropathy: a meta-analysis of 8 randomized trials. J Thromb Thrombolysis 38, 493–502 (2014). https://doi.org/10.1007/s11239-014-1076-3

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