The effects of atorvastatin on contrast-induced acute kidney injury; a systematic review and meta-analysis on clinical trials

Kianoush Saberi ¹ , Ali Rahnama Sisakht ² , Ghasem Sobhani ³ , Faraz Zandiyeh ⁴ , Mohammad Sadegh Golvardi Yazdi ³ , Saeed Soltanizadeh ⁵ , Sara Rasta ⁶ , Farshad Gharebakhshi ⁷ , Mohamad Khaledi ⁸^*

¹ Department of Anesthesiology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
² Student Committee Research, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
³ Department of Anesthesiology, Faculty of Nursing and Midwifery, Anesthesiology Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
⁴ Department of Emergency Medicine, Shohadaye Salamat hospital, Iran University of Medical Sciences, Tehran, Iran
⁵ Student Committee Research, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
⁶ Department of Emergency Medicine, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
⁷ Department of Radiology, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

*Corresponding Author: Corresponding author: Mohamad Khaledi, Email: , Email: Khaledi.mohamad82@gmail.com

Abstract

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a major acute renal failure that can be prevented by atorvastatin administration. This study aims to evaluate the association between atorvastatin use and CI-AKI incidence using a systematic review and meta-analysis approach.

Materials and Methods: Several international databases, including Cochrane, Web of Science, Scopus, ProQuest, PubMed, and the Google Scholar search engine, were queried in this study. STATA 14 software was conducted to analyze the data. In this study, standardized mean difference (SMD) index was conducted to investigate the relationship between atorvastatin and serum creatinine level.

Results: Twelve clinical trials with a total sample size of 3299 were retrieved. The effect of atorvastatin on serum creatinine levels indicated a SMD of -2.26 (95% CI: -2.53, -1.98) at a dose of 20 mg/kg, -0.76 (95% CI: -1.47, -0.05) at a dose of 40 mg/kg, -2.69 (95% CI: -2.96, -2.42) at a dose of 60 mg/ kg, and -0.03 (95% CI: -0.14, 0.09) at a dose of 80 mg/kg. The effect of atorvastatin use on serum creatinine levels achieved a SMD of -2.72 (95% CI: -3.02, -2.43) in the 40-49 years age group and a SMD of -0.96 (95% CI: -1.73, -0.19) in the 50-59 years age group. The effect of high-dose atorvastatin therapy in reducing the serum creatinine levels, compared to low-dose therapy, was a SMD of -0.54 (95% CI: -1.03, -0.04). However, estimates for the effect of atorvastatin compared to rosuvastatin and placebo showed a SMD of -0.26 (95% CI: -0.76, 0.24) and -1.23 (95% CI: -2.22, -0.25), respectively. The effect of atorvastatin on blood urea nitrogen (BUN) and high-sensitivity C-reactive protein (hs-CRP) levels relative to the comparison group was a SMD of -1.10 (95% CI: -1.61, -0.58) and -1.36 (95% CI: -2.30, -0.42) respectively.

Conclusion: Pre-treatment with atorvastatin is effective in CI-AKI prevention. High-dose atorvastatin administration at younger ages provides the best outcome for preventing CI-AKI.

Meta-analysis Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID: CRD42023397276, available at https:// www.crd.york.ac.uk/prospero/#recordDetails).

Keywords: Atorvastatin, Liptonorm, Atorvastatin calcium trihydrate, Acute kidney injury, Acute renal failure, Acute renal insufficiency, Contrast media

Implication for health policy/practice/research/medical education:

In a systematic review and meta-analysis on the published clinical trials, we found atorvastatin administration proves effective in contrastinduced acute kidney injury (CI-AKI) prevention. Younger patients represent the most suitable candidates for this treatment. Additionally, the effect of the high-dose atorvastatin regimen was higher than the low-dose regimen. Thus, clinicians should consider atorvastatin as a protective agent against CI-AKI incidence. For better insight, future clinical trials are suggested to compare the effectiveness of various atorvastatin doses in preventing CI-AKI.

Please cite this paper as: Saberi K, Rahnama Sisakht A, Sobhani G, Zandiyeh F, Golvardi Yazdi MS, Soltanizadeh S, Rasta S, Gharebakhshi F, Khaledi M. The effects of atorvastatin on contrast-induced acute kidney injury; a systematic review and meta-analysis on clinical trials. J Nephropathol. 2023;x(x):e21452. DOI: 10.34172/jnp.2023.21452.