Coronary artery disease
Usefulness of Atorvastatin (80 mg) in Prevention of Contrast-Induced Nephropathy in Patients With Chronic Renal Disease

https://doi.org/10.1016/j.amjcard.2009.09.026Get rights and content

We investigated the efficacy of short-term high-dose atorvastatin in decreasing the risk of contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) subjected to coronary angiography and/or angioplasty. CIN occurs in up to 15% of patients with pre-existing CKD and affects clinical outcome. The protective effect of statin therapy against CIN is still controversial. A prospective, single-center study of 304 patients with baseline estimated creatinine clearance <60 ml/min were randomized to receive atorvastatin 80 mg/day or placebo for 48 hours before and 48 hours after contrast medium administration. All patients received intravenous saline hydration and oral N-acetylcysteine 1,200 mg 2 times/day. Iso-osmolar contrast medium was used. CIN was defined as an absolute increase of serum creatinine ≥0.5 mg/dl within 5 days after the procedure. CIN occurred in 31 patients (10%), 16 (11%) in the placebo group and 15 (10%) in the atorvastatin group (p = 0.86). Mean increase in creatinine was not significantly different in the 2 groups (0.59 ± 0.17 in placebo group vs 0.72 ± 0.26 mg/dl in atorvastatin group, p = 0.31). Persistent kidney injury, defined as 1-month increase from baseline creatinine value ≥25%, was observed in 30% in the placebo group and in 31% in the atorvastatin group (p = 0.58). In conclusion, a short-term administration of high doses of atorvastatin before and after contrast exposure, in addition to standard intravenous hydration and oral N-acetylcysteine, does not decrease CIN occurrence in patients with pre-existing CKD.

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Methods

This was a prospective, randomized, placebo-controlled trial performed in patients with baseline CKD undergoing elective coronary angiography and/or other intervention. From April 2006 to March 2008, 1,542 patients underwent planned coronary angiographic procedures at our institution. Of these, 551 patients had a preangiographic estimated creatinine clearance <60 ml/min—evaluated by applying the Cockcroft-Gault formula19—and were considered eligible for inclusion in our study. Exclusion

Results

The median age for the entire study cohort was 75 years (interquartile range 71 to 81). Mean baseline estimated creatinine clearance was 46 ± 10 ml/min and 8% of patients had severe renal impairment with estimated creatinine clearance <30 ml/min. There were no significant differences in baseline clinical, biochemical, and procedural characteristics between the atorvastatin and placebo groups (Table 1).

Mean creatinine values are listed in Table 2. No differences were found in baseline and

Discussion

In this prospective, randomized trial of 304 patients with moderate to severe CKD who underwent coronary angiographic procedures and were pretreated with intravenous hydration and oral NAC, prophylactic addition of short-term high-dose atorvastatin did not determine a further decrease of CIN occurrence compared to the placebo group (10% vs 11%, respectively). This finding was consistent in the entire prospectively defined higher-risk subgroup. Furthermore, no significant differences were found

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