Department of Medicine, California Institute of Behavioral Neurosciences and Psychology, United States.
Department of Medicine, Dow Medical College, Karachi, Pakistan.
Hong Kong Med J. 2019 Jun;25(3):216-221. doi: 10.12809/hkmj187459. Epub 2019 May 29.
Acute renal failure secondary to contrast-induced acute kidney injury (CI-AKI) is one of the most commonly encountered problems in hospitalised patients. The CI-AKI may lead to the development of persistent renal disease, causing significant morbidity and mortality in high-risk patients. Statins are increasingly recognised as effective in preventing CI-AKI. In this review, we reviewed the literature on statin use for prophylaxis of CI-AKI, its potential benefits, and adverse effects. The aim of the present review was to reveal gaps and discrepancies in the available literature, and to identify areas for future research.
We searched PubMed for articles published up to 2018, using keywords including: "Statins AND contrast-induced kidney injury", "3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors AND contras-induced kidney injury", and "HMG-CoA reductase inhibitors AND contrast induced nephropathy".
Various trials and reviews have yielded promising results in terms of statin efficacy. However, conflicting results and a lack of homogeneity in the protocols of these trials have limited the applicability of statin-based therapy in clinical practice. Despite the reported beneficial therapeutic effects of short-term high-dosage statin use in preventing CI-AKI, statin therapy is not yet the standard prophylactic regimen due to widespread heterogeneity in the clinical trials.
Statin therapy can be used as an adjunct to usual prophylactic measures such as adequate hydration and use of low-volume contrast media. Large well-designed trials on the effects of short-term high-dose statin use in preventing CI-AKI should be conducted, to eliminate any form of discrepancy among results, and to clarify any potential adverse effects.
继发于造影剂导致的急性肾损伤（CI-AKI）的急性肾衰竭是住院患者中最常见的问题之一。CI-AKI 可能导致持续性肾脏疾病的发展，在高危患者中引起显著的发病率和死亡率。他汀类药物在预防 CI-AKI 方面的作用已得到越来越多的认可。在本综述中，我们回顾了他汀类药物预防 CI-AKI 的应用、潜在益处和不良反应的文献。本综述的目的是揭示现有文献中的差距和差异，并确定未来研究的方向。
我们在 PubMed 上搜索了截至 2018 年发表的文章，使用的关键词包括：“他汀类药物和造影剂诱导的肾损伤”、“3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂和造影剂诱导的肾损伤”以及“HMG-CoA 还原酶抑制剂和造影剂诱导的肾病”。
各种试验和综述在他汀类药物的疗效方面都取得了有希望的结果。然而，这些试验方案的结果相互矛盾且缺乏一致性，限制了他汀类药物在临床实践中的应用。尽管短期高剂量他汀类药物预防 CI-AKI 的治疗效果已得到报道，但由于临床试验中存在广泛的异质性，他汀类药物治疗尚未成为标准的预防方案。
他汀类药物治疗可以作为充分水化和使用低剂量造影剂等常规预防措施的辅助手段。应进行大型设计良好的关于短期高剂量他汀类药物预防 CI-AKI 效果的试验，以消除结果中的任何形式的差异，并阐明任何潜在的不良反应。
