Cho AJin, Lee Young-Ki, Sohn Seo Young
Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.
Medicine (Baltimore). 2020 Mar;99(10):e19473. doi: 10.1097/MD.0000000000019473.
Renal insufficiency is an important predictor of contrast-induced acute kidney injury (CI-AKI). We performed a meta-analysis to examine the effects of short-term statin therapy on the incidence of CI-AKI, particularly in patients with renal insufficiency.
A systematic search was conducted to retrieve randomized controlled trials (RCTs) that investigated the impact of statin pretreatment before administration of contrast media on the development of CI-AKI in patients with mild to moderate renal insufficiency. The primary outcome was development of CI-AKI. The secondary outcome was the incidence ofacute kidney injury requiring hemodialysis.
Data analysis from 8 RCTs, which included a total of 2313 subjects in the statin-treated group and 2322 in the control group, showed that statin pretreatment was associated with significant reduction of the risk of CI-AKI (relative risk [RR] = 0.59; 95% confidential interval [CI] 0.44-0.79; P = .0003, I = 0%). A beneficial effect of statin on preventing CI-AKI was consistent, regardless of the dose of statin and use of N-acetylcysteine. In subgroup analysis based on baseline estimated glomerular filtration rate (eGFR), patients with baseline eGFR <60 mL/min/1.73 m (RR = 0.63; 95% CI 0.41-0.98; P = .04, I = 0%) and 30 < eGFR < 90 mL/min/1.73 m (RR = 0.56; 95% CI 0.39-0.82; P = .003, I = 0%) showed significant reduction of risk of CI-AKI.
Statin pretreatment is effective at preventing CI-AKI and should be considered in patients with preexisting renal insufficiency.
肾功能不全是对比剂诱导的急性肾损伤（CI-AKI）的重要预测指标。我们进行了一项荟萃分析，以研究短期他汀类药物治疗对CI-AKI发生率的影响，尤其是对肾功能不全患者的影响。
进行系统检索，以获取随机对照试验（RCT），这些试验研究了在轻度至中度肾功能不全患者中，造影剂给药前他汀类药物预处理对CI-AKI发生的影响。主要结局是CI-AKI的发生。次要结局是需要血液透析的急性肾损伤的发生率。
对8项RCT进行的数据分析显示，他汀类药物预处理组共有2313名受试者，对照组有2322名受试者，结果表明他汀类药物预处理与CI-AKI风险的显著降低相关（相对风险[RR]=0.59；95%置信区间[CI]0.44-0.79；P=0.0003，I=0%）。无论他汀类药物的剂量和N-乙酰半胱氨酸的使用情况如何，他汀类药物对预防CI-AKI都有有益作用。在基于基线估计肾小球滤过率（eGFR）的亚组分析中，基线eGFR<60 mL/min/1.73 m²（RR=0.63；95%CI 0.41-0.98；P=0.04，I=0%）和30<eGFR<90 mL/min/1.73 m²（RR=0.56；95%CI 0.39-0.82；P=0.003，I=0%）的患者显示CI-AKI风险显著降低。
他汀类药物预处理可有效预防CI-AKI，对于已有肾功能不全的患者应予以考虑。
