Vanmassenhove Jill, Vanholder Raymond, Lameire Norbert
Renal Division, Ghent University Hospital, Ghent, Belgium.
Curr Opin Nephrol Hypertens. 2016 Nov;25(6):508-517. doi: 10.1097/MNH.0000000000000261.
To highlight the most recently published meta-analyses on the role of statins in the prevention of contrast-induced acute kidney injury (CI-AKI) and to formulate recommendations for clinical practice.
Nine meta-analyses were published on this topic from January 2015 to April 2016. Significant clinical heterogeneity between studies, regarding study population, treatment protocol, concomitant preventive strategies or dosage and duration of statin therapy was observed. In addition, the definition of CI-AKI was not uniform throughout all studies, and a number of other clinically meaningful endpoints, such as length of hospital stay in patients who developed CI-AKI, as well as adverse events, were rarely analyzed.
Despite some promising results, it is premature to adapt the existing guidelines and implement the preprocedural use of statins in daily clinical practice. At present, low volumes of iso-osmolar or low-osmolar intravascular contrast and adequate intravascular hydration in high-risk patients remain the cornerstone for the prevention of CI-AKI. There is a need for additional well designed randomized controlled trials to clarify these issues and assess the risk vs benefit of statin use for the purpose of CI-AKI prevention.
重点介绍他汀类药物在预防对比剂诱导的急性肾损伤（CI-AKI）方面最新发表的荟萃分析，并为临床实践制定建议。
2015年1月至2016年4月期间，关于该主题发表了9项荟萃分析。研究发现，在研究人群、治疗方案、伴随的预防策略或他汀类药物治疗的剂量和持续时间方面，各研究之间存在显著的临床异质性。此外，所有研究中CI-AKI的定义并不统一，一些其他具有临床意义的终点，如发生CI-AKI患者的住院时间以及不良事件，很少被分析。
尽管有一些令人鼓舞的结果，但在日常临床实践中调整现有指南并实施术前使用他汀类药物还为时过早。目前，低剂量的等渗或低渗血管内造影剂以及对高危患者进行充分的血管内补液仍然是预防CI-AKI的基石。需要更多设计良好的随机对照试验来阐明这些问题，并评估使用他汀类药物预防CI-AKI的风险与益处。
