Efficacy of Statins for Contrast Induced Nephropathy (CIN) Prevention in Cardiac Intervention Surgery Patients: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LITing , GONGXu-dong , ZHANGXue-feng , XIAOChun-hui , GUYong-liang , WANGRi-chun

Haiyan People's Hospital of Zhejiang Province, Jiaxing 314300, China;

Corresponding author：

Keywords：

Statins; Contrast induced nephropathy; Prevention; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20150211

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy of statins for contrast induced nephropathy (CIN) prevention in cardiac intervention surgery patients. Methods We electronically searched databases including PubMed, Web of Knowledge, The Cochrane Library (Issue 5, 2015), VIP, WanFang Data and CNKI to collect randomized controlled trials (RCTs) about statins for CIN prevention in cardiac intervention surgery patients from inception to May 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 25 RCTs involving 37 353 patients were included, among them, 3 794 were CIN patients. The results of meta-analysis indicated that: compared with the placebo/blank group, the incidence rate of CIN was decreased in the statins group with a significant difference (OR=0.68, 95%CI 0.63 to 0.73, P<0.000 01). Conclusion Current evidence shows statins can reduce incidence of CIN in cardiac intervention surgery patients. Due to limited quality and quantity of the included studies, the above conclusions need more high quality studies to verify.

Citation： LITing, GONGXu-dong, ZHANGXue-feng, XIAOChun-hui, GUYong-liang, WANGRi-chun. Efficacy of Statins for Contrast Induced Nephropathy (CIN) Prevention in Cardiac Intervention Surgery Patients: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(11): 1277-1283. doi: 10.7507/1672-2531.20150211 Copy

1.	McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol, 2008, 51(15):1419-1428.
2.	Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis, 2002, 39(5):930-936.
3.	James MT, Ghali WA, Tonelli M, et al. Acute kidney injury following coronary angiography is associated with a long-term decline in kidney function. Kidney Int, 2010, 78(8):803-809.
4.	Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrastinduced nephropathy with sodium bicarbonate:a randomized controlled trial. JAMA, 2004, 291(19):2328-2334.
5.	Marenzi G, Marana I, Lauri G, et al. The prevention of radiocontrastagent-induced nephropathy by hemofiltration. N Engl J Med, 2003, 349(14):1333-1340.
6.	Stone GW, McCullough PA, Tumlin JA, et al. Fenoldopam mesylate for the prevention of contrast-induced nephropathy:a randomized controlled trial. JAMA, 2003, 290(17):2284-2291.
7.	Marenzi G, Assanelli E, Marana I, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med, 2006, 354(26):2773-2782.
8.	From AM, Bartholmai BJ, Williams AW, et al. Sodium bicarbonate is associated with an increased incidence of contrast nephropathy:a retrospective cohort study of 7977 patients at mayo clinic. Clin J Am Soc Nephrol, 2008, 3(1):10-18.
9.	Ridker PM, Rifai N, Clearfield M, et al. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med, 2001, 344(26):1959-1965.
10.	Khanal S, Attallah N, Smith DE, et al. Statin therapy reduces contrast-induced nephropathy:an analysis of contemporary percutaneous interventions. Am J Med, 2005, 118(8):843-849.
11.	Zhao JL, Yang YJ, Zhang YH, et al. Effect of statins on contrastinduced nephropathy in patients with acute myocardial infarction treated with primary angioplasty. Int J Cardiol, 2008, 126(3):435-436.
12.	Kandula P, Shah R, Singh N, et al. Statins for prevention of contrastinduced nephropathy in patients undergoing non-emergent percutaneous coronary intervention. Nephrology (Carlton), 2010, 15(2):165-170.
13.	Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011] . Available at:http://www.cochrane-handbook.org.
14.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. J Clin Epidemiol, 2009, 62(10):1006-1012.
15.	Attallah N, Yassine L, Musial J, et al. The potential role of statins in contrast nephropathy. Clin Nephrol, 2004, 62(4):273-278.
16.	Jo SH, Koo BK, Park JS, et al. Prevention of radiocontrast mediuminduced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial--a randomized controlled study. Am Heart J, 2008, 155(3):499. e491-498.
17.	Patti G, Nusca A, Chello M, et al. Usefulness of statin pretreatment to prevent contrast-induced nephropathy and to improve longterm outcome in patients undergoing percutaneous coronary intervention. Am J Cardiol, 2008, 101(3):279-285.
18.	Bouzas-Mosquera A, Vazquez-Rodriguez JM, Calvino-Santos R, et al. Statin therapy and contrast-induced nephropathy after primary angioplasty. Int J Cardiol, 2009, 134(3):430-431.
19.	Xinwei J, Xianghua F, Jing Z, et al. Comparison of usefulness of simvastatin 20 mg versus 80 mg in preventing contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol, 2009, 104(4): 519-524.
20.	Yoshida S, Kamihata H, Nakamura S, et al. Prevention of contrastinduced nephropathy by chronic pravastatin treatment in patients with cardiovascular disease and renal insufficiency. J Cardiol, 2009, 54(2):192-198.
21.	Acikel S, Muderrisoglu H, Yildirir A, et al. Prevention of contrastinduced impairment of renal function by short-term or long-term statin therapy in patients undergoing elective coronary angiography. Blood Coagul Fibrinolysis, 2010, 21(8):750-757.
22.	Ozhan H, Erden I, Ordu S, et al. Efficacy of short-term high-dose atorvastatin for prevention of contrast-induced nephropathy in patients undergoing coronary angiography. Angiology, 2010, 61(7): 711-714.
23.	Toso A, Maioli M, Leoncini M, et al. Usefulness of atorvastatin (80 mg) in prevention of contrast-induced nephropathy in patients with chronic renal disease. Am J Cardiol, 2010, 105(3):288-292.
24.	Patti G, Ricottini E, Nusca A, et al. Short-term, high-dose Atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the ARMYDA-CIN[atorvastatin for reduction of myocardial damage during angioplasty--contrastinduced nephropathy] trial. Am J Cardiol, 2011, 108(1):1-7.
25.	董国峰, 吴尚勤, 姚青海, 等. 他汀类药物预防冠脉介入术后造影剂肾病的研究. 天津医科大学学报, 2011, 17(3):365-366, 372.
26.	张东亚, 朱静, 陈建昌, 等. 阿托伐他汀对造影剂肾病的预防作用. 苏州大学学报(医学版), 2011, 31(2):290-293.
27.	Li W, Fu X, Wang Y, et al. Beneficial effects of high-dose atorvastatin pretreatment on renal function in patients with acute ST-segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention. Cardiology, 2012, 122(3):195-202.
28.	管笑丹. 他汀类药物对应用造影剂时肾脏保护的临床研究. 中国现代药物应用, 2012, 6(21):66-68.
29.	何贵新. 大剂量阿托伐他汀联合水化对老年急诊PCI术后造影剂肾病的保护作用. 中国临床药理学杂志, 2012, 28(8):578-580, 605.
30.	徐验, 王丽丽, 黄素风, 等. 大剂量阿托伐他汀对急诊冠状动脉介入治疗患者对比剂肾病的影响. 岭南心血管病杂志, 2012, 18(4): 403-407.
31.	季康, 陈宇强, 田东华, 等. 阿托伐他汀联合静脉水化预防冠状动脉造影患者对比剂肾病的研究. 中华临床医师杂志(电子版), 2013, 7(17):8037-8038.
32.	卢义琼, 李华波. 匹伐他汀钙对冠心病患者行冠状动脉造影术后肾功能的保护作用及其机制. 中国医院药学杂志, 2013, 33(15): 1266-1269.
33.	牟英, 罗彩东, 刘云兵. 术前高剂量阿托伐他汀负荷对急性冠脉综合征患者PCI术后肾功能的影响. 四川医学, 2013, 34(11):1690-1691.
34.	石增刚, 桑更生, 张亮, 等. 阿托伐他汀对造影剂肾病的预防. 内蒙古医学杂志, 2013, 45(6):690-691.
35.	王福贵, 徐梅, 李文华, 等阿托伐他汀预防冠心病患者介入诊疗术后对比剂肾病的疗效观察. 中国实用医药, 2013, 8(2):144-145.
36.	王金会, 李琳, 赵慧娟, 等. 阿托伐他汀治疗对比剂肾病的疗效观察. 中国医药指南, 2013, 11(10):429-430.
37.	Han Y, Zhu G, Han L, et al. Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease. J Am Coll Cardiol, 2014, 63(1): 62-70.
38.	Leoncini M, Toso A, Maioli M, et al. Early high-dose rosuvastatin for contrast-induced nephropathy prevention in acute coronary syndrome:Results from the PRATO-ACS Study (Protective Effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with Acute Coronary Syndrome). J Am Coll Cardiol, 2014, 63(1):71-79.
39.	Mohammed NM, Mahfouz A, Achkar K, et al. Contrast-induced Nephropathy. Heart Views, 2013, 14(3):106-116.
40.	De Luca G, Navarese EP, Suryapranata H. A meta-analytic overview of thrombectomy during primary angioplasty. Int J Cardiol, 2013, 166(3):606-612.
41.	Navarese EP, De Luca G, Castriota F, et al. Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction:a meta-analysis. J Thromb Haemost, 2011, 9(10):1902-1915.
42.	马宝新, 李花, 刘现亮, 等. 经皮冠状动脉介入术前他汀治疗预防围手术期患者心肌梗死效果的Meta分析. 中国循证医学杂志, 2012, 12(9):1110-1115.
43.	石伟, 刘增长, 苏立, 等. 他汀类药物治疗心房颤动随机对照试验的Meta分析. 中国循证医学杂志, 2009, 9(5):570-573.
44.	Wang W, Zhang B. Statins for the prevention of stroke:a metaanalysis of randomized controlled trials. PLoS One, 2014, 9(3): e92388.
45.	Deedwania PC. Statins in chronic kidney disease:cardiovascular risk and kidney function. Postgrad Med, 2014, 126(1):29-36.
46.	崔文鹏, 杜冰, 贾冶, 等. 他汀类药物治疗早期糖尿病肾病的Meta分析. 中国循证医学杂志, 2010, 10(1):81-88.
47.	Kwok CS, Pang CL, Yeong JK, et al. Measures used to treat contrastinduced nephropathy:overview of reviews. Br J Radiol, 2013, 86(1021):20120272.
48.	隋准, 王宓, 王梅. 他汀类药物对造影剂肾病预防效果的荟萃分析. 中国血液净化, 2010, 9(12):658-661.
49.	Quintavalle C, Fiore D, De Micco F, et al. Impact of a high loading dose of atorvastatin on contrast-induced acute kidney injury. Circulation, 2012, 126(25):3008-3016.
50.	Park JK, Muller DN, Mervaala EM, et al. Cerivastatin prevents angiotensin Ⅱ-induced renal injury independent of blood pressureand cholesterol-lowering effects. Kidney Int, 2000, 58(4):1420-1430.
51.	Gueler F, Rong S, Park JK, et al. Postischemic acute renal failure is reduced by short-term statin treatment in a rat model. J Am Soc Nephrol, 2002, 13(9):2288-2298.

1. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol, 2008, 51(15):1419-1428.
2. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis, 2002, 39(5):930-936.
3. James MT, Ghali WA, Tonelli M, et al. Acute kidney injury following coronary angiography is associated with a long-term decline in kidney function. Kidney Int, 2010, 78(8):803-809.
4. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrastinduced nephropathy with sodium bicarbonate:a randomized controlled trial. JAMA, 2004, 291(19):2328-2334.
5. Marenzi G, Marana I, Lauri G, et al. The prevention of radiocontrastagent-induced nephropathy by hemofiltration. N Engl J Med, 2003, 349(14):1333-1340.
6. Stone GW, McCullough PA, Tumlin JA, et al. Fenoldopam mesylate for the prevention of contrast-induced nephropathy:a randomized controlled trial. JAMA, 2003, 290(17):2284-2291.
7. Marenzi G, Assanelli E, Marana I, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med, 2006, 354(26):2773-2782.
8. From AM, Bartholmai BJ, Williams AW, et al. Sodium bicarbonate is associated with an increased incidence of contrast nephropathy:a retrospective cohort study of 7977 patients at mayo clinic. Clin J Am Soc Nephrol, 2008, 3(1):10-18.
9. Ridker PM, Rifai N, Clearfield M, et al. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med, 2001, 344(26):1959-1965.
10. Khanal S, Attallah N, Smith DE, et al. Statin therapy reduces contrast-induced nephropathy:an analysis of contemporary percutaneous interventions. Am J Med, 2005, 118(8):843-849.
11. Zhao JL, Yang YJ, Zhang YH, et al. Effect of statins on contrastinduced nephropathy in patients with acute myocardial infarction treated with primary angioplasty. Int J Cardiol, 2008, 126(3):435-436.
12. Kandula P, Shah R, Singh N, et al. Statins for prevention of contrastinduced nephropathy in patients undergoing non-emergent percutaneous coronary intervention. Nephrology (Carlton), 2010, 15(2):165-170.
13. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011] . Available at:http://www.cochrane-handbook.org.
14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. J Clin Epidemiol, 2009, 62(10):1006-1012.
15. Attallah N, Yassine L, Musial J, et al. The potential role of statins in contrast nephropathy. Clin Nephrol, 2004, 62(4):273-278.
16. Jo SH, Koo BK, Park JS, et al. Prevention of radiocontrast mediuminduced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial--a randomized controlled study. Am Heart J, 2008, 155(3):499. e491-498.
17. Patti G, Nusca A, Chello M, et al. Usefulness of statin pretreatment to prevent contrast-induced nephropathy and to improve longterm outcome in patients undergoing percutaneous coronary intervention. Am J Cardiol, 2008, 101(3):279-285.
18. Bouzas-Mosquera A, Vazquez-Rodriguez JM, Calvino-Santos R, et al. Statin therapy and contrast-induced nephropathy after primary angioplasty. Int J Cardiol, 2009, 134(3):430-431.
19. Xinwei J, Xianghua F, Jing Z, et al. Comparison of usefulness of simvastatin 20 mg versus 80 mg in preventing contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol, 2009, 104(4): 519-524.
20. Yoshida S, Kamihata H, Nakamura S, et al. Prevention of contrastinduced nephropathy by chronic pravastatin treatment in patients with cardiovascular disease and renal insufficiency. J Cardiol, 2009, 54(2):192-198.
21. Acikel S, Muderrisoglu H, Yildirir A, et al. Prevention of contrastinduced impairment of renal function by short-term or long-term statin therapy in patients undergoing elective coronary angiography. Blood Coagul Fibrinolysis, 2010, 21(8):750-757.
22. Ozhan H, Erden I, Ordu S, et al. Efficacy of short-term high-dose atorvastatin for prevention of contrast-induced nephropathy in patients undergoing coronary angiography. Angiology, 2010, 61(7): 711-714.
23. Toso A, Maioli M, Leoncini M, et al. Usefulness of atorvastatin (80 mg) in prevention of contrast-induced nephropathy in patients with chronic renal disease. Am J Cardiol, 2010, 105(3):288-292.
24. Patti G, Ricottini E, Nusca A, et al. Short-term, high-dose Atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the ARMYDA-CIN[atorvastatin for reduction of myocardial damage during angioplasty--contrastinduced nephropathy] trial. Am J Cardiol, 2011, 108(1):1-7.
25. 董国峰, 吴尚勤, 姚青海, 等. 他汀类药物预防冠脉介入术后造影剂肾病的研究. 天津医科大学学报, 2011, 17(3):365-366, 372.
26. 张东亚, 朱静, 陈建昌, 等. 阿托伐他汀对造影剂肾病的预防作用. 苏州大学学报(医学版), 2011, 31(2):290-293.
27. Li W, Fu X, Wang Y, et al. Beneficial effects of high-dose atorvastatin pretreatment on renal function in patients with acute ST-segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention. Cardiology, 2012, 122(3):195-202.
28. 管笑丹. 他汀类药物对应用造影剂时肾脏保护的临床研究. 中国现代药物应用, 2012, 6(21):66-68.
29. 何贵新. 大剂量阿托伐他汀联合水化对老年急诊PCI术后造影剂肾病的保护作用. 中国临床药理学杂志, 2012, 28(8):578-580, 605.
30. 徐验, 王丽丽, 黄素风, 等. 大剂量阿托伐他汀对急诊冠状动脉介入治疗患者对比剂肾病的影响. 岭南心血管病杂志, 2012, 18(4): 403-407.
31. 季康, 陈宇强, 田东华, 等. 阿托伐他汀联合静脉水化预防冠状动脉造影患者对比剂肾病的研究. 中华临床医师杂志(电子版), 2013, 7(17):8037-8038.
32. 卢义琼, 李华波. 匹伐他汀钙对冠心病患者行冠状动脉造影术后肾功能的保护作用及其机制. 中国医院药学杂志, 2013, 33(15): 1266-1269.
33. 牟英, 罗彩东, 刘云兵. 术前高剂量阿托伐他汀负荷对急性冠脉综合征患者PCI术后肾功能的影响. 四川医学, 2013, 34(11):1690-1691.
34. 石增刚, 桑更生, 张亮, 等. 阿托伐他汀对造影剂肾病的预防. 内蒙古医学杂志, 2013, 45(6):690-691.
35. 王福贵, 徐梅, 李文华, 等阿托伐他汀预防冠心病患者介入诊疗术后对比剂肾病的疗效观察. 中国实用医药, 2013, 8(2):144-145.
36. 王金会, 李琳, 赵慧娟, 等. 阿托伐他汀治疗对比剂肾病的疗效观察. 中国医药指南, 2013, 11(10):429-430.
37. Han Y, Zhu G, Han L, et al. Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease. J Am Coll Cardiol, 2014, 63(1): 62-70.
38. Leoncini M, Toso A, Maioli M, et al. Early high-dose rosuvastatin for contrast-induced nephropathy prevention in acute coronary syndrome:Results from the PRATO-ACS Study (Protective Effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with Acute Coronary Syndrome). J Am Coll Cardiol, 2014, 63(1):71-79.
39. Mohammed NM, Mahfouz A, Achkar K, et al. Contrast-induced Nephropathy. Heart Views, 2013, 14(3):106-116.
40. De Luca G, Navarese EP, Suryapranata H. A meta-analytic overview of thrombectomy during primary angioplasty. Int J Cardiol, 2013, 166(3):606-612.
41. Navarese EP, De Luca G, Castriota F, et al. Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction:a meta-analysis. J Thromb Haemost, 2011, 9(10):1902-1915.
42. 马宝新, 李花, 刘现亮, 等. 经皮冠状动脉介入术前他汀治疗预防围手术期患者心肌梗死效果的Meta分析. 中国循证医学杂志, 2012, 12(9):1110-1115.
43. 石伟, 刘增长, 苏立, 等. 他汀类药物治疗心房颤动随机对照试验的Meta分析. 中国循证医学杂志, 2009, 9(5):570-573.
44. Wang W, Zhang B. Statins for the prevention of stroke:a metaanalysis of randomized controlled trials. PLoS One, 2014, 9(3): e92388.
45. Deedwania PC. Statins in chronic kidney disease:cardiovascular risk and kidney function. Postgrad Med, 2014, 126(1):29-36.
46. 崔文鹏, 杜冰, 贾冶, 等. 他汀类药物治疗早期糖尿病肾病的Meta分析. 中国循证医学杂志, 2010, 10(1):81-88.
47. Kwok CS, Pang CL, Yeong JK, et al. Measures used to treat contrastinduced nephropathy:overview of reviews. Br J Radiol, 2013, 86(1021):20120272.
48. 隋准, 王宓, 王梅. 他汀类药物对造影剂肾病预防效果的荟萃分析. 中国血液净化, 2010, 9(12):658-661.
49. Quintavalle C, Fiore D, De Micco F, et al. Impact of a high loading dose of atorvastatin on contrast-induced acute kidney injury. Circulation, 2012, 126(25):3008-3016.
50. Park JK, Muller DN, Mervaala EM, et al. Cerivastatin prevents angiotensin Ⅱ-induced renal injury independent of blood pressureand cholesterol-lowering effects. Kidney Int, 2000, 58(4):1420-1430.
51. Gueler F, Rong S, Park JK, et al. Postischemic acute renal failure is reduced by short-term statin treatment in a rat model. J Am Soc Nephrol, 2002, 13(9):2288-2298.

Chinese Journal of Evidence-Based Medicine

Efficacy of Statins for Contrast Induced Nephropathy (CIN) Prevention in Cardiac Intervention Surgery Patients: A Meta-analysis

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