Does Perioperative Statin Reduce Acute Kidney Injury After Cardiac Surgery?

Study Questions:

Does short-term high-dose perioperative atorvastatin reduce acute kidney injury (AKI) following cardiac surgery?

Methods:

This was a double-blinded, placebo-controlled, single-center, randomized clinical trial of adult cardiac surgery patients. Patients naive to statin treatment were randomized to receive 80 mg of atorvastatin the day prior to surgery, 40 mg of atorvastatin the morning of surgery (at least 3 hours prior to surgery), and 40 mg of atorvastatin daily following surgery. The primary outcome was AKI, defined as an increase of 0.3 mg/dl in serum creatinine concentration within 48 hours of surgery.

Results:

A total of 615 patients (199 naive to statin treatment and 416 already taking a statin) were included in the primary analysis; 308 were randomized to atorvastatin and 307 to placebo. Among all patients, the primary endpoint of AKI occurred in 64 of 308 (20.8%) in the atorvastatin group compared with 60 of 307 (19.5%) in the placebo group (p = 0.75). In the subgroup of patients with CKD and naive to statin treatment (n = 36), AKI occurred in 9 of 17 (52.9%) in the atorvastatin group compared with 3 of 19 (15.8%) in the placebo group (relative risk, 3.35; 95% confidence interval, 1.12-10.05; p = 0.03).

Conclusions:

Compared to placebo, high-dose perioperative atorvastatin did not reduce the risk of AKI in patients undergoing cardiac surgery.

Perspective:

This is an important study because it establishes that there is no benefit to perioperative statin therapy in patients undergoing cardiac surgery. Such therapy may be harmful and cause AKI in those with chronic kidney disease. Based on these results, an argument cannot be made to support the initiation of statin therapy to prevent AKI following cardiac surgery.

Clinical Topics: Cardiac Surgery, Clinical Topic Collection: Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Nonstatins, Novel Agents, Statins, Interventions and Structural Heart Disease

Keywords: Acute Kidney Injury, Cardiac Surgical Procedures, Creatinine, Heart Valve Diseases, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Kidney Failure, Chronic, Perioperative Care, Renal Insufficiency, Chronic, Risk, Secondary Prevention


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