Original title: Impact of a High Loading Dose of Atorvastatin on Contrast-Induced Acute Kidney Injury. Reference: Quintavalle et al. CIRCULATIONAHA.112.10331, 2012

Patients included in this study represent a subgroup with chronic renal failure (CRF) enrolled in the NAPLES II trial who were randomized to atorvastatin 80 mg 24 hours before angioplasty, (n = 202) versus the control group (n = 208). 

All patients received high doses of N-acetylcysteine and hydration with sodium bicarbonate solution. Serum cystatin C was used as laboratory value to determine kidney function. We investigated the effects in vivo and in vitro of atorvastatin in acute renal injury.

A 10% increase in the concentration of serum cystatin C within 24 hours after contrast exposure occurred in 9 patients, (4.5%), of the atorvastatin group versus 37 patients, (18.4%), in the control group, (p = 0.0005). This difference represents a 78% reduction in the likelihood of developing nephropathy contrast. Atorvastatin reduced the risk in diabetics, (OR 0.62 p = 0.002), in non-diabetics, (OR 0.56, p = 0.006), and in patients with GFR between 31 and 60 ml/min/1, 73 m2 (OR 0, 13 p <0.001). However, the risk did not change in patients with GFR

The in vitro results indicate that the use of atorvastatin reduces the stress protein kinase preventing renal cell apoptosis and restores survival signal pathways mediated by protein kinases Akt and Erks.

Conclusion 

A high dose of atorvastatin administered 24 hours before contrast exposure is effective in reducing the risk of acute kidney injury.

Editorial Comment:

The risk of contrast nephropathy varies depending on the population and percentages that have been reported to range from less than 1% to over 50%. The action of statins on the protein kinases pathways levels, gives us another tool for the prevention of contrast nephropathy. One limitation of the study is the use of serum cystatin C instead of serum creatinine to determine kidney function.

Courtesy of Gustavo Hidalgo, MD
Interventional Cardiology Fellowship
Fundación Favaloro 

Dr. Gustavo Hidalgo.