Preoperative Statin Use and Postoperative Acute Kidney Injury
What is the impact of preprocedural statin use on postoperative kidney injury?
The authors retrospectively assessed the impact of preprocedural statin use on outcome of 98,939 patients who underwent a major open abdominal, cardiac, thoracic, or vascular procedure between 2000 and 2010. Statin users were pair-matched to nonusers on the basis of surgery type, baseline kidney function, days from admission until surgery, and propensity score based on demographics, comorbid conditions, and concomitant medications. Associations between statin use and acute kidney injury were estimated by conditional logistic regression.
Use of statins was associated with a reduction in the composite of acute kidney injury (as defined by Acute Kidney Injury Network [AKIN]-1) or renal replacement therapy (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.72-0.82), or need for renal replacement therapy (OR, 0.74; 95% CI, 0.58-0.95). The protective effect of statins was preserved among both diabetics and nondiabetics, and was most pronounced among patients undergoing vascular surgery and least among patients undergoing cardiac surgery.
The authors concluded that preoperative statin use is associated with a decreased risk of postoperative acute kidney injury.
Prior studies have demonstrated a reduction in major adverse cardiac events with preoperative statin therapy in patients undergoing vascular surgery (N Engl J Med 2009;361:980-9). This study corroborates prior observation studies demonstrating a reduction in kidney injury with statins in patients undergoing major surgery. Given the large number of patients who undergo surgical procedures annually, these findings could have important health care implications. The lack of randomized data prevents any assessment of causality, and a large randomized controlled trial is needed to assess if preoperative statin therapy would be beneficial in preventing postoperative renal (and nonrenal) morbidity.
Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Acute Kidney Injury, Renal Replacement Therapy
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