08 Nov Acute Kidney Injury Following Heart Surgery: Do Statins Help?

Dr. Frederic T.Billings

MedicalResearch.com Interview with:
Frederic T. (Josh) Billings IV, MD, Msc
Assistant Professor of Anesthesiology and Critical Care Medicine
Vanderbilt University Medical Center 

Medical Research: What is the background for this study? What are the main findings?

Dr. Billings: Acute kidney injury (AKI) following cardiac surgery is common (affects 20-30% of patients), and even mild forms of AKI are independently associated with a five-fold increase in death. Statins, commonly prescribed to reduce cholesterol concentrations and cardiovascular disease, affect several mechanisms underlying surgical AKI. Observational studies comparing rates of AKI between statin users and non-users have yielded inconsistent results and don’t assess the effect of statin use during the surgical period.

In a double blind, placebo-controlled, randomized clinical trial of 653 cardiac surgery patients, we found that high-dose atorvastatin given prior to surgery, the day of surgery and daily postoperatively did not affect AKI. In fact, among statin-naïve patients with pre-existing kidney disease, rates of AKI were higher in those randomized to atorvastatin compared to those randomized to placebo. In patients who were using statins prior to the study, rates of AKI were similar between those randomized to atorvastatin and those randomized to placebo (short-term withdrawal), regardless of baseline kidney function. Safety markers of muscle and liver toxicity were not affected by statin treatment.

Medical Research: What should clinicians and patients take away from your report?

Dr. Billings: For statin users, short-term withdrawal of statin use at the time of cardiac surgery does not affect AKI. For those naïve to statins with pre-existing renal disease, initiation of high-dose statin use just before surgery may increase AKI.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Billings: Alternative strategies to improve endothelial function and reduce oxidative injury during cardiac surgery should be employed to reduce AKI.

Citation:

Abstract presented at the ASN 2015 Kidney Week November 2015

High Dose Perioperative Atorvastatin and  AKI following Cardiac Surgery

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Frederic T. (Josh) Billings IV, MD, Msc (2015). Acute Kidney Injury Following Heart Surgery: Do Statins Help? 

Last Updated on November 8, 2015 by Marie Benz MD FAAD