Short-Term Rosuvastatin Therapy for Prevention of Contrast-Induced Acute Kidney Injury in Patients With Diabetes and Chronic Kidney Disease
What is the safety and efficacy of rosuvastatin in preventing contrast-induced acute kidney injury (CIAKI) in patients with diabetes mellitus (DM) and chronic kidney disease (CKD)?
This was a multicenter, prospective, randomized, controlled trial in Chinese patients with DM mellitus and concomitant stage 2 or 3 CKD who were exposed to contrast media during coronary/peripheral arterial diagnostic angiography, left ventriculography, or percutaneous coronary intervention (PCI). Patients (who had not received any statin treatment for at least 14 days) were randomized to either rosuvastatin 10 mg every evening from 2 days before to 3 days after contrast medium administration, or control group (patients in the control group did not receive any statins). Hydration therapy was standard (isotonic saline 12 hours before and continued for 24 hours following contrast medium administration) and at the physician’s discretion. The primary endpoint was the development of CIAKI (defined as an increase in serum creatinine ≥0.5 mg/dl or ≥25% above baseline at 72 hours after exposure to the contrast medium).
A total of 3,082 patients were enrolled from 53 centers in China (1,498 patients were allocated to the rosuvastatin group and 1,500 to the control group). Those randomized to the rosuvastatin group had a significantly lower incidence of CIAKI compared to those in the control group (2.3% vs. 3.9%; p = 0.01; odds ratio, 0.58; 95% confidence interval, 0.38-0.89). The trend for CIAKI occurrence was the same in both statin-naïve and non-naïve patients.
A short course of periprocedural rosuvastatin therapy reduced the incidence of CIAKI in patients with type 2 DM and stage 2 and 3 CKD exposed to iodinated contrast.
The authors indicated, ‘Our results provide strong indications that patients with DM and CKD should receive short-term rosuvastatin to prevent CIAKI, regardless of whether they previously used statins or not.’ It is not clear if the observed benefit is related strictly to rosuvastatin or statins in general. And, it is not clear from this study whether the continuation of pre-existing statin or periprocedural dosing is beneficial. The potential for adverse outcomes from ‘statin withdrawal’ also exists in the control group. In practice, most diabetic patients referred for angiography will probably already be on statin medication.
Keywords: Fluorobenzenes, Odds Ratio, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Acute Kidney Injury, Pyrimidines, Creatinine, Percutaneous Coronary Intervention, Contrast Media, Dyslipidemias, Renal Insufficiency, China, Cardiology, Confidence Intervals, Diabetes Mellitus, Sulfonamides
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