Tang Ling-Er, Xu Da-Min, Xu Ling-Yi, Zhao You-Lu, Zhu Yi-Dan, Lv Ji-Cheng, Yang Li, Zheng Xi-Zi
Renal Division, Department of Medicine, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, China.
China Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
Front Med (Lausanne). 2025 Sep 1;12:1639130. doi: 10.3389/fmed.2025.1639130. eCollection 2025.
Chronic kidney disease (CKD) constitutes a substantial burden in terms of cardiovascular disease and acute kidney injury (AKI). While statins are recommended for their cardiovascular benefits in CKD patients, their impact on AKI remains inconclusive.
A retrospective screening was conducted on all adult hospital admissions from January 1, 2018, to December 31, 2020, including patients with CKD. Statin exposure was defined as any prescription within 48 h of admission. Patients were monitored until death, discharge, or a maximum of 30 days. The primary outcome was in-hospital AKI, with in-hospital mortality as the secondary outcome.
In a cohort of 5,376 patients, the median age was 72 years; 3,184 (59.2%) were male, and 2,129 (39.6%) were statin users. In-hospital AKI was observed in 149 (7.0%) of statin users compared to 213 (6.6%) of non-users. Statin use was significantly associated with a reduced risk of in-hospital AKI [adjusted hazard ratio [aHR], 0.74; 95% confidence interval [CI], 0.56-0.96] and in-hospital mortality (aHR, 0.45; 95% CI, 0.24-0.88). These outcomes were consistent across subgroup analyses stratified by age, gender, baseline estimated glomerular filtration rate (eGFR), and cardiovascular disease (all for interaction >0.05), as well as in sensitivity analyses excluding patients who discontinued statin therapy during hospitalization or initiated statin therapy post-baseline. Among atorvastatin users (63.4%, 1,350/2,129), only medium-dose atorvastatin was significantly associated with reduced risk of in-hospital AKI after full adjustment (aHR, 0.68; 95% CI, 0.49-0.95).
Statin use may improve survival and reduced AKI risk in hospitalized patients with CKD, with atorvastatin showing particularly favorable renoprotective effects.
慢性肾脏病（CKD）在心血管疾病和急性肾损伤（AKI）方面构成了沉重负担。虽然他汀类药物因其对CKD患者的心血管益处而被推荐使用，但其对AKI的影响仍无定论。
对2018年1月1日至2020年12月31日期间所有成年住院患者进行回顾性筛查，包括CKD患者。他汀类药物暴露定义为入院后48小时内的任何处方。对患者进行监测直至死亡、出院或最长30天。主要结局是院内AKI，院内死亡率作为次要结局。
在5376例患者队列中，中位年龄为72岁；3184例（59.2%）为男性，2129例（39.6%）为他汀类药物使用者。他汀类药物使用者中有149例（7.0%）发生院内AKI，而非使用者中有213例（6.6%）发生。使用他汀类药物与降低院内AKI风险显著相关[调整后风险比[aHR]，0.74；95%置信区间[CI]，0.56 - 0.96]以及院内死亡率（aHR，0.45；95%CI，0.24 - 0.88）。在按年龄、性别、基线估计肾小球滤过率（eGFR）和心血管疾病分层的亚组分析中（所有交互作用P>0.05），以及在排除住院期间停用他汀类药物治疗或基线后开始他汀类药物治疗的患者的敏感性分析中，这些结果均一致。在阿托伐他汀使用者中（63.4%，1350/2129），完全调整后只有中等剂量阿托伐他汀与降低院内AKI风险显著相关（aHR，0.68；95%CI，0.49 - 0.95）。
使用他汀类药物可能改善CKD住院患者的生存率并降低AKI风险，阿托伐他汀显示出特别有利的肾脏保护作用。
