Statins reduce risk of contrast-induced acute kidney injury
By Will Boggs MD
NEW YORK (Reuters Health) - For patients undergoing percutaneous coronary procedures, statin administration is the only strategy consistently associated with a reduction in the risk of contrast-induced acute kidney injury (CIAKI), according to a network meta-analysis.
"Many physicians rely on simple hydration for CIAKI prevention, but this is the least effective strategy if it is not coupled with other preventive therapies,” Dr. Davide Capodanno from Ferrarotto Hospital, University of Catania, Italy, told Reuters Health by email.
Numerous approaches have been tried, but the optimal CIAKI-prevention strategy for patients undergoing percutaneous coronary procedures for suspected or confirmed coronary artery disease remains unknown.
Dr. Capodanno and colleagues performed a network meta-analysis of 124 randomized trials including more than 28,000 patients in an effort to evaluate the true effectiveness of 10 preventive strategies for CIAKI.
Compared with saline, the risk of CIAKI was most consistently reduced by statins (a 58% risk reduction), according to their findings, online May 9 in Circulation: Cardiovascular Interventions.
Xanthines, represented by theophylline, also provided a significant reduction in the risk of CIAKI compared with saline, but there was a high degree of heterogeneity across studies.
The use of N-acetylcysteine, sodium bicarbonate and combinations of the two also reduced the risk of CIAKI, although results were inconsistent and associated with considerable heterogeneity across studies. Periprocedural hydration alone was the least effective preventive treatment.
In subgroup analyses, none of the strategies reduced the risk of CIAKI compared with saline in patients with diabetes.
Most studies received low quality ratings: about 50% of trials did not ensure any blinding, about 55% did not properly describe the process of random sequence generation, 60% to 65% of trials had unclear performance of allocation concealment and only about 80% had blinded events adjudication.
“CIAKI is associated with increased mortality and morbidity; therefore, strategies aimed at prevention should be put in place,” Dr. Capodanno concluded. “I think data are now quite robust for issuing a stronger recommendation for statins as a CIAKI-preventing therapy in subjects at risk.”
“There is a need for more research in the field of CIAKI prevention for patients with diabetes mellitus,” he added. “In this subset, no preventive therapy has so far been shown to be effective.”
The authors reported no financial disclosures.
Circ Cardiovasc Interv 2017.
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