How do statins affect the prognosis of acute kidney injury (AKI)?

Updated: Dec 24, 2020
  • Author: Biruh T Workeneh, MD, PhD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The relationship between statins and AKI is complex. [29] In addition to rare cases of statins causing rhabdomyolysis, use of high-potency statins has been associated with an increased rate of diagnosis for AKI in hospital admissions, compared with use of low-potency statins, particularly in the first 120 days after initiation of statin treatment. [30]

On the other hand, preprocedural statin therapy has been shown to reduce contrast-induced AKI in patients undergoing coronary angiography. [31, 32]

Research on perioperative statins has yielded mixed results. A retrospective study in more than 200,000 patients older than 66 years who underwent elective surgery suggested that patients taking statins had a lesser incidence and lower severity of AKI, as well as lower mortality, than did individuals not on statins. [33] In a meta-analysis of patients undergoing major surgery, preoperative statin therapy was associated with a significant risk reduction for cumulative postoperative AKI and postoperative AKI requiring renal preplacement therapy, but when the analysis was restricted to randomized controlled trials, the protective effect was not significant. [34]

A meta-analysis in adult patients who required surgery with cardiac bypass found no association between preoperative statin use and a decrease in the incidence of AKI. [35] Similarly, a meta-analysis in patients undergoing cardiac surgery (mainly, myocardial revascularization), found that preoperative statin treatment had no influence on perioperative renal failure. [36] In contrast, in another meta-analysis of patients undergoing cardiac surgery, preoperative statin therapy significantly reduced the incidence of postoperative renal dysfunction and the need for postoperative renal replacement therapy. [37]


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