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. 2012 Dec;125(12):1195-1204.e3.
doi: 10.1016/j.amjmed.2012.06.021. Epub 2012 Oct 9.

Preoperative statin use and postoperative acute kidney injury

Steven M Brunelli  1 , Sushrut S Waikar, Brian T Bateman, Tara I Chang, Joyce Lii, Amit X Garg, Wolfgang C Winkelmayer, Niteesh K Choudhry
Affiliations

Preoperative statin use and postoperative acute kidney injury

Steven M Brunelli et al. Am J Med. 2012 Dec.

Abstract

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.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) between preoperative statin use vs nonuse and postoperative acute kidney injury in matched cohort stratified on baseline estimated glomerular filtration rate (eGFR). [Note: eGFR ≤30 and 31–45 collapsed due to sparseness]. AKIN = Acute Kidney Injury Network; RIFLE = Risk-Injury-Failure; RRT = renal replacement therapy.
Figure 2
Figure 2
Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) between preoperative statin use vs nonuse and postoperative acute kidney injury in matched cohort stratified on diabetes mellitus (DM). AKIN = Acute Kidney Injury Network; RIFLE = Risk-Injury-Failure; RRT = renal replacement therapy.
Figure 3
Figure 3
Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) between preoperative statin use vs nonuse and postoperative acute kidney injury in matched cohort stratified on type of surgery. AKIN = Acute Kidney Injury Network; RIFLE = Risk-Injury-Failure; RRT = renal replacement therapy.
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