Elsevier

Canadian Journal of Cardiology

Volume 27, Issue 6, November–December 2011, Pages 851-858
Canadian Journal of Cardiology

Systematic review/meta-analysis
High-Dose Statin Pretreatment for the Prevention of Contrast-Induced Nephropathy: A Meta-analysis

https://doi.org/10.1016/j.cjca.2011.05.005Get rights and content

Abstract

Background

Contrast-induced nephropathy (CIN) is a rare but serious complication following contrast-based procedures. Statins have been postulated to prevent CIN via various mechanisms. However, the outcomes following statin administration to prevent CIN have been inconsistent.

Methods

A meta-analysis of published randomized clinical trials was performed to determine if short-term administration of high-dose statin is superior to conventional-dose statin or placebo among patients undergoing catheterization and interventional procedures in preventing CIN.

Results

Data were combined across 8 published clinical trials in which 1423 patients were identified. Pooled analyses showed that short-term high-dose statin treatment can decrease the occurrence of CIN (risk ratio 0.51, 95% confidence interval [CI], 0.34-0.77; P = 0.001) and 48-hour serum creatinine level (standardized mean difference [SMD] –0.07 mg/dL; 95% CI, –0.11 to –0.04 mg/dL; P < 0.00001). However, subgroup analysis showed that statin pretreatment cannot decrease the occurrence of CIN in patients with preexisting renal impairment (RR 0.90; 95% CI, 0.49-1.65; P = 0.73). No evidence of publication bias was detected.

Conclusions

This meta-analysis supports the effectiveness of short-term high-dose statin pretreatment for both decreasing the level of serum creatinine and reducing the rate of CIN in patients undergoing diagnostic and interventional procedures requiring contrast media. However, prospective clinical trials will be needed to draw a definitive conclusion in this area.

Résumé

Introduction

La néphropathie induite par les produits de contraste (NIC) est une complication rare, mais sérieuse, à la suite d'examens de contraste. Les statines sont présumées prévenir la NIC par divers mécanismes. Cependant, les résultats suivant l'administration de statines pour prévenir la NIC ont été inconsistants.

Méthodes

Une métaanalyse d'essais cliniques aléatoires publiés a été faite pour déterminer si l'administration à court terme de doses élevées de statines est supérieure à la dose usuelle de statines ou au placebo chez les patients subissant une cathétérisation et des procédures interventionnelles en prévention de la NIC.

Résultats

Les données ont été combinées à partir de 8 essais cliniques publiés parmi lesquels 1 423 patients ont été identifiés. Les analyses groupées ont montré qu'un traitement à court terme à doses élevées de statines peut diminuer l'occurrence de la NIC (risque relatif [RR] de 0,51, intervalle de confiance [IC] de 95 %, 0,34-0,77; P = 0,001) et le niveau de créatinine sérique après 48 heures (déviation standard moyenne [DMS]) –0,07 mg/dl; IC de 95 %, –0,11 à –0,04 mg/dl; P < 0,00001). Cependant, l'analyse par sous-groupe a montré qu'un prétraitement par statines ne peut pas diminuer l'occurrence de la NIC chez les patients avec une insuffisance rénale préexistante (RR de 0,90; IC de 95 %, 0,49-1,65; P = 0,73). Aucune preuve de biais de publication n'a été trouvée.

Conclusions

Cette métaanalyse appuie l'efficacité d'un prétraitement à court terme à doses élevées de statines tant pour la diminution du niveau de créatinine sérique que pour la réduction du taux de NIC chez les patients subissant un diagnostic et des procédures interventionnelles nécessitant un produit de contraste. Cependant, des essais cliniques prospectifs seront nécessaires pour tirer une conclusion définitive dans ce domaine.

Section snippets

Materials and Methods

Our prespecified inclusion criteria were as follows: the subjects were adults; the reports were in the English or Chinese language literature; high-dose statins a priori (defined as a daily dose of 80 mg or 40 mg12, 13) were administered; periprocedural administration was described as immediately preceding or within 24 hours of the planned contrast exposure; prospective trials were of individuals randomized to statin, administered orally, vs a control group; and trials included the incidence of

Description of studies

Of the 67 potentially relevant reports initially screened, a total of 8 trials were identified.7, 8, 9, 10, 11, 15, 16, 17 Eight trials with a total of 1423 patients (695 assigned to high-dose statin and 728 assigned to the control arm) were included, and the relevant data extracted. The characteristics of included trials are described in Table 1, Table 2, Table 3, Table 4. Five trials in English and 3 trials in Chinese were retrieved with full text of journal articles. The subject population

Discussion

The present meta-analysis based on currently available published randomized clinical trials demonstrates that the administration of high-dose statin pretreatment is superior to low-dose statin or placebo in preventing CIN among patients undergoing diagnostic and interventional procedures requiring contrast media. In addition, short-term prophylaxis with high-dose statin therapy tended to be associated with reduction in serum creatinine after coronary artery angiography. However, subgroup

Conclusions

The present analysis suggests that statins at individual periprocedural doses 80 mg or 40 mg per day decrease the incidence of CIN (none of the trials reported significant side effects). Further prospective studies are needed to better understand the value of high-dose statins in protecting against CIN.

Disclosures

The authors have no conflicts of interest to disclose.

References (27)

  • R. Solomon et al.

    Contrast-induced acute kidney injury

    Circulation

    (2010)
  • R. Lencioni et al.

    Contrast-induced nephropathy in patients undergoing computed tomography (CONNECT): a clinical problem in daily practice?A multicenter observational study

    Acta Radiol

    (2010)
  • D. Reddan et al.

    Contrast-induced nephropathy and its prevention: what do we really know from evidence-based findings?

    J Nephrol

    (2009)
  • Cited by (51)

    • Contrast-induced nephropathy: Basic concepts, pathophysiological implications and prevention strategies

      2017, Pharmacology and Therapeutics
      Citation Excerpt :

      The implementation of high-dose statin before diagnostic catheterization reduces the incidence of CIN and should be considered as an additional preventive measure in patients without contraindications (Authors/Task Force members, 2014). In line with all recent meta-analyses on the comparison of statins versus intravenous saline (Li, Liu, Fu, Mei, & Dai, 2012; Li et al., 2016; Michael et al., 2014; Pappy, Stavrakis, Hennebry, & Abu-Fadel, 2011; Takagi & Umemoto, 2011; Zhang, Li, et al., 2011; Zhou, Yuan, Zhu, & Wang, 2011) except one (Zhang, Shen, et al., 2011), a large recent meta-analysis (Subramaniam, Wilson, et al., 2016) detected a clinically-important protective effect against CIN in populations with chronic kidney disease, diabetes mellitus, cardiac disease, and in general populations when statins were administered in combination with intravenous fluids compared with intravenous fluids alone, or in combination with NAC compared to NAC alone, but the effect was only statistically significant in the latter comparison. The authors concluded that apart from the fact that their findings provide moderate strength of evidence, there are also reasons to move forward with statins cautiously because all studies evaluating their effect to reduce the incidence of CIN have been performed using intra-arterial CM administration and, therefore, the protective effect against CIN for intravenous CM administration is unknown; it is also possible that the findings reported in the studies of statins could be partly explained by a direct effect on GFR that is independent of a protective effect on renal function (Subramaniam, Wilson, et al., 2016).

    • Contrast-induced nephropathy: An update

      2016, Annales de Cardiologie et d'Angeiologie
    View all citing articles on Scopus

    See page 857 for disclosure information.

    View full text