Document Detail


Effect of statin use on acute kidney injury risk following coronary artery bypass grafting.
MedLine Citation:
PMID:  23273532     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute kidney injury (AKI) is a serious complication of cardiovascular surgery. Although some nonexperimental studies suggest that statin use may reduce postsurgical AKI, methodologic differences in study designs leave uncertainty regarding the reality or magnitude of the effect. The aim of this study was to estimate the effect of preoperative statin initiation on AKI after coronary artery bypass grafting (CABG) using an epidemiologic approach more closely simulating a randomized controlled trial in a large CABG patient population. Health care claims from large, employer-based and Medicare insurance databases for 2000 to 2010 were used. To minimize healthy user bias, patients were identified who underwent nonemergent CABG who either newly initiated a statin <20 days before surgery or were unexposed for ≥200 days before CABG. AKI was identified <15 days after CABG. Multivariate-adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using Poisson regression. Analyses were repeated using propensity score methods adjusted for clinical and health care utilization variables. A total of 17,077 CABG patients were identified. Post-CABG AKI developed in 3.4% of statin initiators and 6.2% of noninitiators. After adjustment, a protective effect of statin initiation on AKI was observed (RR 0.78, 95% CI 0.63 to 0.96). This effect differed by age, with an RR of 0.91 (95% CI 0.68 to 1.20) for patients aged ≥65 years and an RR of 0.62 (95% CI 0.45 to 0.86) for those aged <65 years, although AKI was more common in the older group (7.7% vs 4.0%). In conclusion, statin initiation immediately before CABG may modestly reduce the risk for postoperative AKI, particularly in younger CABG patients.
Authors:
J Bradley Layton; Abhijit V Kshirsagar; Ross J Simpson; Virginia Pate; Michele Jonsson Funk; Til Stürmer; M Alan Brookhart
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2012-12-28
Journal Detail:
Title:  The American journal of cardiology     Volume:  111     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-04     Completed Date:  2013-05-16     Revised Date:  2014-03-26    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  823-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / etiology*,  prevention & control*
Age Factors
Aged
Algorithms
Coronary Artery Bypass / adverse effects*
Evidence-Based Medicine
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Male
Middle Aged
Poisson Distribution
Preoperative Care
Risk Assessment
Risk Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
5 T32 DK007750-13/DK/NIDDK NIH HHS; R01 AG018833/AG/NIA NIH HHS; R01 AG023178/AG/NIA NIH HHS; R01 AG023178/AG/NIA NIH HHS; T32 DK007750/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors
Comments/Corrections

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