Dose-dependent dynamics of glomerular filtration rate in patients with reduced renal function in the postinfarction period

Abstract

Abstract Objective To evaluate the effect of 48-week therapy with atorvastatin at various doses on the glomerular filtration rate (GFR) in patients after acute ST-segment elevation myocardial infarction (STEMI). Methods 103 STEMI patients aged 52 (45.5; 59) years (92 men and 11 women) were examined. The patients were randomized into three groups: group 1 – 39 patients taking atorvastatin 80 mg; group 2 – 26 patients who received atorvastatin 40 mg; group 3 – 38 people who took atorvastatin 20 mg. The compared subjects were matched by age, sex, height, BMI, and office BP. All patients were receiving STEMI treatment prior to study entry. Initially and after 24, 48 weeks of follow-up, the creatinine level was determined on an Olympus AU400 analyzer (Olympus Corporation, Japan), followed by the calculation of GFR using the CKD-EPI formula. Results In group 1, GFR was 86.3 at baseline [95% CI 80.3; 92.3], after 24 weeks – 85.1 [95% CI 80.4; 89.7], after 48 weeks – 85.9 [95% CI 80.4; 91.4] ml/min. In group 2, the following GFR values were found: on days 7–9 – 78.4 [95% CI 73; 83.8], after 24 weeks – 82.2 [95% CI 75.5; 89], and 48 weeks – 78.9 [95% CI 74.1; 83.6] ml/min. In group 3, GFR was 88.2 at baseline [95% CI 80.9; 95.5], at the 24th week – 84.9 [95% CI 80.4; 89.4], after 48 weeks of therapy – 81.1 [95% CI 75.5; 86.7] ml/min. Individuals with a baseline decreased GFR <90 ml/min were identified in each group in accordance with the clinical practice guidelines of KDIGO (2012). At the same time, against the background of therapy with atorvastatin 80 mg, a significant increase in GFR from 71.8 [95% CI 67.9; 75.7] to 79.9 [95% CI 74.2; 85.6] after 24 weeks (p=0.02) and the subsequent increase in GFR to 81.0 [95% CI 74.9; 87.2] ml/min after 48 weeks (p=0.02). Against the background lower doses of atorvastatin, GFR dynamics were not observed: in group 2 – 74.0 [95% CI 69.1; 78.9], 79.3 [95% CI 71.5; 87.1], 77.2 [95% CI 71.7; 82.7] ml/min; in group 3 – 70.9 [95% CI 67.6; 74.1], 79.2 [95% CI 73.1; 85.4], 74.9 [95% CI 65.9; 83.9] ml/min. Conclusions In STEMI patients with an initially reduced GFR level, only atorvastatin therapy at a dose of 80 mg for 48 weeks of treatment was accompanied by a significant improvement in renal function. Funding Acknowledgement Type of funding sources: None.