Pretreatment with Rosuvastatin is Associated with 55% Lower Risk of CIN in CKD Patients Undergoing PCI

Contrast-induced nephropathy (CIN) is a common complication of diagnostic or interventional procedures caused by intravascular contrast media administration and is defined as an increase in baseline serum creatinine (SCr) level by ≥25% or an absolute increase of ≥44.2 µmol/L within 48 or 72 hours after administration of contrast media. CIN has become the third leading cause of hospital-acquired acute kidney injury (HA-AKI) following surgical operation and nephrotoxic drug damage, accounting for 11% of the cases. It is closely associated with prolonged hospitalization, increased costs and increased short- and long-term morbidity and mortality. Therefore, a number of strategies have been devised to prevent the incidence of CIN.

Recently, increasing evidence has suggested that statins play a renoprotective role in the progression of CIN by their pleiotropic effect rather than lipid-lowering effect. The pleiotropic effect includes antioxidant, anti-inflammatory, antithrombotic and antiapoptotic properties with enhancement of endothelial nitric oxide production and reduction of endothelin secretion. However, the pleiotropic effects of different statins are different. The hydrophilic statin - rosuvastatin - may have a better tendency to prevent CIN than others, probably owing to a longer plasma half-life and stronger anti-inflammatory effect.

Fifteen RCTs with a total of 2,673 patients were identified and analyzed in a meta-analysis. Patients who received moderate or high-dose rosuvastatin pretreatment had a 55% lower risk of CIN compared with low-dose rosuvastatin pretreatment or placebo group. This meta-analysis demonstrated that moderate or high-dose rosuvastatin treatment could reduce the incidence of CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Moreover, moderate or high-dose rosuvastatin would be beneficial in high-risk patients with CKD or diabetes mellitus or undergoing PCI.