Abstract
The role of statins in reducing the incidence of contrast-induced acute kidney injury (CI-AKI) remains controversial. We sought to evaluate the association between CI-AKI and high plasma exposure of statins in coronary artery disease (CAD) patients undergoing coronary angiography (CAG). This association was first evaluated in 1,219 patients with CAD receiving atorvastatin (AT) therapy and validated in 635 patients receiving rosuvastatin (RST) therapy. The plasma concentrations of statins were quantified using validated UPLC-MS/MS methods and CI-AKI incidence was assessed during the first 48 h postoperatively. Among all participants (n = 1,854), AKI occurred in 57 of 1219 (4.7%) in the AT cohort and 30 of 635 (4.7%) in the RST cohort. High plasma AT-all exposure was associated with increased risk of CI-AKI (odds ratio [OR]: 2.265; 95% confidence interval [CI]: 1.609–3.187; p < 0.0001). Plasma AT-all concentration in the CI-AKI group (22.40 ± 24.63 ng/mL) was 2.6-fold higher than that in the control group (8.60 ± 9.65 ng/mL). High plasma RST exposure also significantly increased the risk of CI-AKI (OR: 2.281; 95% CI: 1.441–3.612; p = 0.0004). We further divided patients into two subgroups for each statin according to baseline renal function, and association between high plasma statin exposure and CI-AKI still remained highly significant in both subgroups. This study suggests for the first time that high plasma exposure of statins may significantly increase the risk of CI-AKI. Statins should be used with greater caution in CAD patients undergoing CAG to reduce the occurrence of CI-AKI.
Highlights
Contrast-induced acute kidney injury (CI-AKI) is a known complication of intravascular administration of contrast media used in coronary angiography (CAG) and percutaneous coronary interventions (PCI) (Chalikias et al, 2016); and is associated with increased mortality, morbidity, healthcare expenditure, and prolonged hospital stay (Nash et al, 2002; Prasad et al, 2016)
Univariate linear regression analysis showed that plasma ATall concentration was affected by age, dosage, SYNTAX score, level of ALT, AST, Scr, estimated glomerular filtration rate (eGFR), and other clinical parameters
Our study demonstrated that high plasma exposure of AT and its metabolites could significantly increase the risk of confidence interval (CI)-AKI, which was further validated and confirmed in patients receiving RST treatment
Summary
Contrast-induced acute kidney injury (CI-AKI) is a known complication of intravascular administration of contrast media used in coronary angiography (CAG) and percutaneous coronary interventions (PCI) (Chalikias et al, 2016); and is associated with increased mortality, morbidity, healthcare expenditure, and prolonged hospital stay (Nash et al, 2002; Prasad et al, 2016). Previous report indicated that even mild postoperative AKI is independently associated with an almost 5-fold increase in in-hospital death (Birnie et al, 2014). The incidence of CI-AKI is greater in patients with cardiovascular diseases or pre-existing renal insufficiency (Goldenberg and Matetzky, 2005; Itoh et al, 2005; Ledneva et al, 2009). The prophylactic benefit of statins in reducing the incidence of CI-AKI has been investigated in several observational (Khanal et al, 2005; Patti et al, 2008; Lev et al, 2009) and randomized studies (Patti et al, 2011); other studies have reported inconsistent and conflicting results (Argalious et al, 2010; Mithani et al, 2011; Billings et al, 2016; Park et al, 2016). To the best of our knowledge, no studies have evaluated the relationship between high plasma exposure of statins and the risk of CI-AKI
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