Statin initiation and acute kidney injury following elective cardiovascular surgery: a population cohort study in Denmark†

Eur J Cardiothorac Surg. 2016 Mar;49(3):995-1000. doi: 10.1093/ejcts/ezv246. Epub 2015 Jul 16.


Objectives: Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-surgical AKI, yet methodological concerns about existing studies raise questions about the magnitude of a protective effect. We sought to determine the effect of initiating a statin prior to elective cardiac surgery on post-surgical AKI in a regional Danish surgical cohort.

Methods: We identified adults who underwent cardiac surgery during 2006-11 using the Western Denmark Heart Registry. Presurgical medication use, pre- and post-surgical serum creatinine (sCr) measures, and other patient characteristics were obtained from Danish population-based registries. Post-surgical AKI was assessed using sCr measures within 5 days of surgery. The adjusted risk ratio (RR) of AKI and 95% confidence interval (CI) were estimated for patients who initiated a statin within 100 days prior to surgery compared with patients without prior statin use; long-term statin users were excluded to reduce healthy-user bias. Subanalyses were stratified by surgery type: coronary artery bypass grafting (CABG) and non-CABG surgeries.

Results: We identified 1929 CABG and 1775 non-CABG patients. AKI occurred in 25% of CABG and 28% of non-CABG surgeries, and in 29% of the non-users and 21% of the statin initiators. Half of CABG patients and 9% of non-CABG patients initiated a statin prior to surgery. The adjusted RRs for the effect of statin initiation on AKI were as follows: all surgeries combined, RR = 0.86 (95% CI: 0.74, 0.98); CABG, RR = 0.88 (0.74, 1.05); non-CABG RR = 0.87 (0.68, 1.11).

Conclusions: Presurgical statin initiation is associated with a reduction in AKI risk after cardiac surgery.

Keywords: Acute kidney injury; Acute renal failure; Perioperative management; Surgical outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / epidemiology*
  • Aged
  • Aged, 80 and over
  • Cardiovascular Surgical Procedures / adverse effects*
  • Cardiovascular Surgical Procedures / statistics & numerical data*
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Male
  • Perioperative Period
  • Risk


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors