What is the role of statins in the prevention of contrast-induced nephropathy (CIN)?

Updated: Dec 18, 2018
  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Statins are widely used in coronary artery disease (CAD) for their pleiotropic effects (favorable effects on endothelin and thrombus formation, plaque stabilization, and anti-inflammatory properties), and it was believed that, given the vascular nature of CIN, they might have similar renoprotective effects. Iniital data for statin use were retrospective and anecdotal, and were taken mostly from patients already on statins who underwent percutaneous coronary intervention (PCI). [41] Subsequently, a meta-analysis of prospective controlled studies found a statistically significant reduction of CIN incidence in patients pretreated with high-dose statins before the procedure (odds ratio [OR], 0.45; 95% confidence interval, 0.34-0.58; P <0.0001).<ref>42</ref>

Another meta-analysis showed that in patients undergoing coronary angiography or PCI, short-term statin use reduced the incidence of CIN; these authors concluded that statins should be used even in patients with low levels of low-density lipoprotein (LDL) cholesterol. Of a total of 4734 patients, CIN occurred in 79 of 2,358 patients (3.3%) who were treated with statins, versus 153 of 2,376 patients (6.4%) who were given placebo (OR 0.50, P< 0.00001). Benefits were observed with both high-dose short-term statins (OR 0.44, P< 0.0001) and low-dose short-term statins (OR 0.58, P = 0.010). [43]

Yet another meta-analysis demonstrated that preprocedural rosuvastatin treatment could significantly reduce the incidence of contrast-induced acute kidney injury (OR 0.49, P < 0.001). However, rosuvstatin treatment did not seem to be effective for preventing contrast-induced acute kidney injury in patients with chronic kidney disease who underwent elective cardiac catheterization. [44]


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