High-dose statin before, after cardiac surgery does not reduce risk of kidney injury

Among patients undergoing cardiac surgery, high-dose treatment with atorvastatin before and after surgery did not reduce the overall risk of acute kidney injury compared with placebo, according to a study published by JAMA. The study is being released to coincide with its presentation at the Society of Critical Care Medicine's 45th Critical Care Congress.

Acute kidney injury (AKI) complicates recovery from cardiac surgery in up to 30% of patients. Statins affect several mechanisms underlying postoperative AKI. Previous studies have found mixed results regarding the effect of statins to reduce AKI in cardiac surgery patients.

Frederic T. Billings IV, MD, MSc, of the Vanderbilt University School of Medicine and colleagues randomly assigned cardiac surgery patients naive to statin treatment (n = 199) to 80 mg of atorvastatin the day before surgery, 40 mg of atorvastatin the morning of surgery, and 40 mg of atorvastatin daily following surgery (n = 102) or matching placebo (n = 97). Patients already taking a statin prior to study enrollment (n = 416) continued taking the pre-enrollment statin until the day of surgery, were randomly assigned 80 mg of atorvastatin the morning of surgery and 40 mg of atorvastatin the morning after (n = 206) or matching placebo (n = 210), and resumed taking the previously prescribed statin on postoperative day two.

Among all participants (n = 615), AKI occurred in 64 of 308 (21%) in the atorvastatin group vs. 60 of 307 (19.5%) in the placebo group. Among patients naive to statin treatment (n = 199), AKI occurred in 22 of l02 (22 percent) in the atorvastatin group vs. 13 of 97 (13 percent) in the placebo group and there was a greater increase in serum creatinine concentration in the atorvastatin group compared to the placebo group. Among patients already taking a statin (n = 416), AKI occurred in 20 percent of the patients in the atorvastatin group vs 22 percent in the placebo group.

"This double-blinded, placebo-controlled randomized clinical trial found no evidence that high-dose perioperative atorvastatin reduces the incidence or severity of AKI following cardiac surgery," the authors wrote. "Among patients naïve to statin treatment, high-dose perioperative atorvastatin increased serum concentrations of creatinine, and there was some evidence that statin treatment may increase AKI among patients naive to statin treatment with preexisting chronic kidney disease. Among patients already taking a statin, there was no evidence that perioperative statin continuation or withdrawal affected postoperative AKI. These results do not support the initiation of statin therapy to prevent AKI following cardiac surgery."