Preoperative Statin Use and Postoperative Acute Kidney Injury - 17/11/12
, Sushrut S. Waikar, MD, MPH b, c, Brian T. Bateman, MD a, c, d, Tara I. Chang, MD, MS e, Joyce Lii, MA, MS a, Amit X. Garg, MD, PhD f, g, Wolfgang C. Winkelmayer, MD, ScD e, Niteesh K. Choudhry, MD, PhD a, c
Requests for reprints should be addressed to Steven M. Brunelli, MD, MSCE, Brigham and Women's Hospital, 1620 Tremont Street, Suite 30303, Boston, MA 02120Abstract |
Background |
Acute kidney injury is a frequent postoperative complication that confers increased mortality, morbidity, and costs. The purpose of this study was to evaluate whether preoperative statin use is associated with a decreased risk of postoperative acute kidney injury.
Methods |
We assembled a retrospective cohort of 98,939 patients who underwent a major open abdominal, cardiac, thoracic, or vascular procedure between 2000 and 2010. Statin users were pair-matched to nonusers on the basis of surgery type, baseline kidney function, days from admission until surgery, and propensity score based on demographics, comorbid conditions, and concomitant medications. Acute kidney injury was defined based on changes in serum creatinine measurements applying Acute Kidney Injury Network and Risk-Injury-Failure staging systems, and on the need for renal replacement therapy. Associations between statin use and acute kidney injury were estimated by conditional logistic regression.
Results |
Across various acute kidney injury definitions, statin use was consistently associated with a decreased risk: adjusted odds ratios (95% confidence intervals) varied from 0.74 (0.58-0.95) to 0.80 (0.71-0.90). Associations were similar among diabetics and nondiabetics, and across strata of baseline kidney function. The protective association of statins was most pronounced among patients undergoing vascular surgery and least among patients undergoing cardiac surgery.
Conclusions |
Preoperative statin use is associated with a decreased risk of postoperative acute kidney injury. Future randomized clinical trials are needed to determine causality.
Le texte complet de cet article est disponible en PDF.Keywords : Acute kidney injury, Acute renal failure, 3-Hydroxy-3-glutaryl Co-A reductase inhibitors, Perioperative complications, Statins, Surgery
Plan
| Funding: This work was supported by a grant from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases: DK079056 (S.M.B.). The NIH had no role in the design or conduct of this study, or in the drafting of this manuscript or decision to publish. |
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| Conflict of Interest: In the past, Dr Brunelli has served on Advisory Boards to CB Fleet Company and Amgen; his spouse is an employee of AstraZeneca. Dr Winkelmayer serves on Advisory boards for Amgen, Fibrogen, and as a consultant to the Harvard Clinical Research Institute. |
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| Authorship: Dr Brunelli had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Brunelli, Waikar, Choudhry; Acquisition of data: Brunelli; Analysis and interpretation of data: Brunelli, Waikar, Bateman, Chang, Lii, Garg, Winkelmayer, Choudhry; Drafting of the manuscript: Brunelli; Critical revision of the manuscript for important intellectual content: Brunelli, Waikar, Bateman, Chang, Lii, Garg, Winkelmayer, Choudhry; Statistical analysis: Brunelli, Lii; Obtained funding: Brunelli; Administrative, technical, or material support: Brunelli, Lii; Study supervision: Brunelli. |
Vol 125 - N° 12
P. 1195 - décembre 2012 Retour au numéro
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