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Efficacy of short-term high-dose statin pretreatment in prevention of contrast-induced acute kidney injury: updated study-level meta-analysis of 13 randomized controlled trials.

Lee JM, Park J, Jeon KH, Jung JH, Lee SE, Han JK, Kim HL, Yang HM, Park KW, Kang HJ, Koo BK, Jo SH, Kim HS - PLoS ONE (2014)

Bottom Line: In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35-0.57, p<0.001, I(2)= 8.2%, NNT 16), compared with low-dose statin or placebo.In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥ 60 years), regardless of osmolality of contrast or administration of N-acetylcystein.High-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Background: There have been conflicting results across the trials that evaluated prophylactic efficacy of short-term high-dose statin pre-treatment for prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG). The aim of the study was to perform an up-to-date meta-analysis regarding the efficacy of high-dose statin pre-treatment in preventing CIAKI.

Methods and results: Randomized-controlled trials comparing high-dose statin versus low-dose statin or placebo pre-treatment for prevention of CIAKI in patients undergoing CAG were included. The primary endpoint was the incidence of CIAKI within 2-5 days after CAG. The relative risk (RR) with 95% CI was the effect measure. This analysis included 13 RCTs with 5,825 total patients; about half of them (n = 2,889) were pre-treated with high-dose statin (at least 40 mg of atorvastatin) before CAG, and the remainders (n = 2,936) pretreated with low-dose statin or placebo. In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35-0.57, p<0.001, I(2)= 8.2%, NNT 16), compared with low-dose statin or placebo. The benefit of high-dose statin was consistent in both comparisons with low-dose statin (RR 0.47, 95% CI 0.34-0.65, p<0.001, I(2) = 28.4%, NNT 19) or placebo (RR 0.34, 95% CI 0.21-0.58, p<0.001, I(2)= 0.0%, NNT 16). In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥ 60 years), regardless of osmolality of contrast or administration of N-acetylcystein.

Conclusions: High-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.

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Related in: MedlinePlus

The effect of high-dose statin on the incidence of contrast-induced acute kidney injury, stratified according to the high-dose versus low-dose statin or high-dose versus placebo.Forest plot with relative risks for the incidence of contrast-induced acute kidney injury associated with (A) high-dose statin versus low-dose statin or (B) high-dose statin versus placebo for individual trials and the pooled population. Abbreviations: CI, confidence intervals; RR, relative risks.
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pone-0111397-g003: The effect of high-dose statin on the incidence of contrast-induced acute kidney injury, stratified according to the high-dose versus low-dose statin or high-dose versus placebo.Forest plot with relative risks for the incidence of contrast-induced acute kidney injury associated with (A) high-dose statin versus low-dose statin or (B) high-dose statin versus placebo for individual trials and the pooled population. Abbreviations: CI, confidence intervals; RR, relative risks.

Mentions: As shown in Figure 1, this meta-analysis included 13 RCTs [11]–[15], [21]–[28], all of which provided the incidence of CIAKI. Figure 2 illustrates the RRs of individual study and pooled RR in regards to the incidence of CIAKI, the primary outcome. The overall incidence of CIAKI in the intention-to-treat population was 3.6% (105/2889) in high-dose statin group and 8.3% (245/2936) in control group, respectively. In pooled analysis using random effects model, patients receiving high-dose statin pre-treatment had 55% less risk of CIAKI compared with the control group (RR 0.45, 95% CI 0.35–0.57, p<0.001) (Figure 2). A fixed effects model yielded a similar result (RR 0.44, 95% CI 0.35–0.55, p<0.001) (Figure S3 in File S1). The number needed to treat (NNT) of high-dose statin was 16 in random effects model which means that treatment of 16 patients with high-dose statin will reduce 1 event of CIAKI. There was no significant heterogeneity in either the random effects or the fixed effects model (I2 = 8.2%, heterogeneity p = 0.364 for both random and fixed effects model). Since 4 trials compared high-dose versus low-dose statin group and 9 trials compared high-dose versus placebo or no treatment, we performed stratified analysis according to the type of treatment (Figure 3). High-dose statin significantly reduced the risk of CIAKI by 53% (RR 0.47, 95% CI 0.34–0.65, p<0.001, I2 = 28.4%, heterogeneity p = 0.192) or 66% (RR 0.34, 95% CI 0.21–0.58, p<0.001, I2 = 0.0%, heterogeneity p = 0.931), when compared with placebo or low-dose statin group, respectively.


Efficacy of short-term high-dose statin pretreatment in prevention of contrast-induced acute kidney injury: updated study-level meta-analysis of 13 randomized controlled trials.

Lee JM, Park J, Jeon KH, Jung JH, Lee SE, Han JK, Kim HL, Yang HM, Park KW, Kang HJ, Koo BK, Jo SH, Kim HS - PLoS ONE (2014)

The effect of high-dose statin on the incidence of contrast-induced acute kidney injury, stratified according to the high-dose versus low-dose statin or high-dose versus placebo.Forest plot with relative risks for the incidence of contrast-induced acute kidney injury associated with (A) high-dose statin versus low-dose statin or (B) high-dose statin versus placebo for individual trials and the pooled population. Abbreviations: CI, confidence intervals; RR, relative risks.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219719&req=5

pone-0111397-g003: The effect of high-dose statin on the incidence of contrast-induced acute kidney injury, stratified according to the high-dose versus low-dose statin or high-dose versus placebo.Forest plot with relative risks for the incidence of contrast-induced acute kidney injury associated with (A) high-dose statin versus low-dose statin or (B) high-dose statin versus placebo for individual trials and the pooled population. Abbreviations: CI, confidence intervals; RR, relative risks.
Mentions: As shown in Figure 1, this meta-analysis included 13 RCTs [11]–[15], [21]–[28], all of which provided the incidence of CIAKI. Figure 2 illustrates the RRs of individual study and pooled RR in regards to the incidence of CIAKI, the primary outcome. The overall incidence of CIAKI in the intention-to-treat population was 3.6% (105/2889) in high-dose statin group and 8.3% (245/2936) in control group, respectively. In pooled analysis using random effects model, patients receiving high-dose statin pre-treatment had 55% less risk of CIAKI compared with the control group (RR 0.45, 95% CI 0.35–0.57, p<0.001) (Figure 2). A fixed effects model yielded a similar result (RR 0.44, 95% CI 0.35–0.55, p<0.001) (Figure S3 in File S1). The number needed to treat (NNT) of high-dose statin was 16 in random effects model which means that treatment of 16 patients with high-dose statin will reduce 1 event of CIAKI. There was no significant heterogeneity in either the random effects or the fixed effects model (I2 = 8.2%, heterogeneity p = 0.364 for both random and fixed effects model). Since 4 trials compared high-dose versus low-dose statin group and 9 trials compared high-dose versus placebo or no treatment, we performed stratified analysis according to the type of treatment (Figure 3). High-dose statin significantly reduced the risk of CIAKI by 53% (RR 0.47, 95% CI 0.34–0.65, p<0.001, I2 = 28.4%, heterogeneity p = 0.192) or 66% (RR 0.34, 95% CI 0.21–0.58, p<0.001, I2 = 0.0%, heterogeneity p = 0.931), when compared with placebo or low-dose statin group, respectively.

Bottom Line: In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35-0.57, p<0.001, I(2)= 8.2%, NNT 16), compared with low-dose statin or placebo.In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥ 60 years), regardless of osmolality of contrast or administration of N-acetylcystein.High-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Background: There have been conflicting results across the trials that evaluated prophylactic efficacy of short-term high-dose statin pre-treatment for prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG). The aim of the study was to perform an up-to-date meta-analysis regarding the efficacy of high-dose statin pre-treatment in preventing CIAKI.

Methods and results: Randomized-controlled trials comparing high-dose statin versus low-dose statin or placebo pre-treatment for prevention of CIAKI in patients undergoing CAG were included. The primary endpoint was the incidence of CIAKI within 2-5 days after CAG. The relative risk (RR) with 95% CI was the effect measure. This analysis included 13 RCTs with 5,825 total patients; about half of them (n = 2,889) were pre-treated with high-dose statin (at least 40 mg of atorvastatin) before CAG, and the remainders (n = 2,936) pretreated with low-dose statin or placebo. In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35-0.57, p<0.001, I(2)= 8.2%, NNT 16), compared with low-dose statin or placebo. The benefit of high-dose statin was consistent in both comparisons with low-dose statin (RR 0.47, 95% CI 0.34-0.65, p<0.001, I(2) = 28.4%, NNT 19) or placebo (RR 0.34, 95% CI 0.21-0.58, p<0.001, I(2)= 0.0%, NNT 16). In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥ 60 years), regardless of osmolality of contrast or administration of N-acetylcystein.

Conclusions: High-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.

Show MeSH
Related in: MedlinePlus