Impact of high loading dose of atorvastatin in diabetic patients with renal dysfunction undergoing elective percutaneous coronary intervention: a randomized controlled trial.

Abstract

The effectiveness of statin pretreatment in reducing the incidence of contrast-induced nephropathy (CIN) has been examined in some observational and randomized studies, yielding controversial results. This study sought to evaluate the role of atorvastatin in prevention of CIN in diabetic patients with mild-to-moderate chronic kidney disease (CKD), undergoing elective percutaneous coronary intervention (PCI). 130 patients with mean glomerular filtration rate of 48.5±16mL/min/1.73m were prospectively enrolled, then randomly (double blind) assigned in 1:1 ratio to receive atorvastatin (80mg daily for 48h) or placebo. Serum creatinine and glomerular filtration rate were measured preintervention, 72h and 10days thereafter. An increase in serum creatinine by >0.5mg/dL (44.2μmol/L) or >25% of baseline value was considered as CIN. Mean age of the study cohort was 56±5years (males: 62%). Mean serum creatinine level in the placebo group increased significantly 3days after coronary intervention and declined on the 10th day to a level that did not differ significantly from the baseline level, but still higher. However, in atorvastatin group, mean serum creatinine level showed a nonsignificant rise on the third day and then decreased to a level close to the baseline one, on the 10th day. Incidence of CIN was 7.7% in atorvastatin group and 20% in the placebo group (P<0.05). Atorvastatin dose of 80mg per day for 48h is associated with decreased incidence of CIN in diabetic patients with CKD undergoing PCI.