Statin Use Associates with a Lower Incidence of Acute Kidney Injury After Major Elective Surgery

Overview

Journal J Am Soc Nephrol

Specialty Nephrology

Date 2011 Apr 16

PMID 21493769

Citations 48

Authors

Amber O Molnar

Steven G Coca

Phillip J Devereaux

Arsh K Jain

Abhijat Kitchlu

Jin Luo

Chirag R Parikh

J Michael Paterson

Nausheen Siddiqui

Ron Wald

Michael Walsh

Amit X Garg

Affiliations

Soon will be listed here.

Abstract

Statins abrogate ischemic renal injury in animal studies but whether they are renoprotective in humans is unknown. We conducted a population-based retrospective cohort study that included 213,347 older patients who underwent major elective surgery in the province of Ontario, Canada from 1995 to 2008. During the first 14 postoperative days, 1.9% (4020 patients), developed acute kidney injury and 0.5% (1173 patients), required acute dialysis. The 30-day mortality rate was 2.8% (5974 patients). Prior to surgery, 32% of patients were taking a statin. After statistical adjustment for patient and surgical characteristics, statin use associated with 16% lower odds of acute kidney injury (OR, 0.84; 95% CI, 0.79 to 0.90), 17% lower odds of acute dialysis (OR, 0.83; 95% CI, 0.72 to 0.95), and 21% lower odds of mortality (OR, 0.79; 95% CI, 0.74 to 0.85). Propensity score matching produced similar results. These data suggest that statins may protect against renal complications after major elective surgery and reduce perioperative mortality.

Citing Articles

Effect of statins and antihyperglycemics on chronic kidney disease in patients with type 2 diabetes mellitus: a retrospective cohort study with a 12-year follow-up.

Jairoun A, Ping C, Ibrahim B, Al Jawamis D, Al Jaberi A, Dawoud T J Pharm Policy Pract. 2025; 18(1):2414293.

PMID: 39776464 PMC: 11703420. DOI: 10.1080/20523211.2024.2414293.

Fenoldopam for preventing and treating acute kidney injury.

Esezobor C, Bhatt G, Effa E, Hodson E Cochrane Database Syst Rev. 2024; 11():CD012905.

PMID: 39607014 PMC: 11603559. DOI: 10.1002/14651858.CD012905.pub2.

Statin use in total joint arthroplasty: a systematic review.

Baghdadi S, Babagoli M, Soleimani M, Ramezani A, Ghaseminejad-Raeini A, Siavashi B Ann Med Surg (Lond). 2024; 86(6):3423-3431.

PMID: 38846882 PMC: 11152855. DOI: 10.1097/MS9.0000000000002063.

Effects of statins on the incidence and outcomes of acute kidney injury in critically ill patients: a systematic review and meta-analysis.

Vahedian-Azimi A, Heidari Beni F, Fras Z, Banach M, Mohammadi S, Jamialahmadi T Arch Med Sci. 2023; 19(4):952-964.

PMID: 37560738 PMC: 10408035. DOI: 10.5114/aoms/159992.

Genetic variations in HMGCR and PCSK9 and kidney function: a Mendelian randomization study.

Park S, Kim S, Lee S, Kim Y, Cho S, Kim K Kidney Res Clin Pract. 2023; 42(4):460-472.

PMID: 37448291 PMC: 10407636. DOI: 10.23876/j.krcp.22.237.

References

Dunkelgrun M, Boersma E, Schouten O, Koopman-van Gemert A, van Poorten F, Bax J . Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg. 2009; 249(6):921-6. DOI: 10.1097/SLA.0b013e3181a77d00. View

Juurlink D, Mamdani M, Lee D, Kopp A, Austin P, Laupacis A . Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004; 351(6):543-51. DOI: 10.1056/NEJMoa040135. View

Alter D, Naylor C, Austin P, Tu J . Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med. 1999; 341(18):1359-67. DOI: 10.1056/NEJM199910283411806. View

Waikar S, Wald R, Chertow G, Curhan G, Winkelmayer W, Liangos O . Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure. J Am Soc Nephrol. 2006; 17(6):1688-94. DOI: 10.1681/ASN.2006010073. View

Gueler F, Rong S, Park J, Fiebeler A, Menne J, Elger M . Postischemic acute renal failure is reduced by short-term statin treatment in a rat model. J Am Soc Nephrol. 2002; 13(9):2288-98. DOI: 10.1097/01.asn.0000026609.45827.3d. View

Quan H, Parsons G, Ghali W . Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data. Med Care. 2004; 42(8):801-9. DOI: 10.1097/01.mlr.0000132391.59713.0d. View

Mamdani M, Sykora K, Li P, Normand S, Streiner D, Austin P . Reader's guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ. 2005; 330(7497):960-2. PMC: 556348. DOI: 10.1136/bmj.330.7497.960. View

Sharyo S, Yokota-Ikeda N, Mori M, Kumagai K, Uchida K, Ito K . Pravastatin improves renal ischemia-reperfusion injury by inhibiting the mevalonate pathway. Kidney Int. 2008; 74(5):577-84. DOI: 10.1038/ki.2008.210. View

Jha P, DeBoer D, Sykora K, Naylor C . Characteristics and mortality outcomes of thrombolysis trial participants and nonparticipants: a population-based comparison. J Am Coll Cardiol. 1996; 27(6):1335-42. DOI: 10.1016/0735-1097(96)00018-6. View

10.

Lindenauer P, Pekow P, Wang K, Gutierrez B, Benjamin E . Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA. 2004; 291(17):2092-9. DOI: 10.1001/jama.291.17.2092. View

11.

Ricci Z, Cruz D, Ronco C . The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int. 2007; 73(5):538-46. DOI: 10.1038/sj.ki.5002743. View

12.

Devarajan P . Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol. 2006; 17(6):1503-20. DOI: 10.1681/ASN.2006010017. View

13.

Mangano C, Diamondstone L, Ramsay J, Aggarwal A, Herskowitz A, Mangano D . Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med. 1998; 128(3):194-203. DOI: 10.7326/0003-4819-128-3-199802010-00005. View

14.

Kheterpal S, Tremper K, Englesbe M, OReilly M, Shanks A, Fetterman D . Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology. 2007; 107(6):892-902. DOI: 10.1097/01.anes.0000290588.29668.38. View

15.

Platt A, Kuna S, Field S, Chen Z, Gupta R, Roche D . Adherence to sleep apnea therapy and use of lipid-lowering drugs: a study of the healthy-user effect. Chest. 2009; 137(1):102-8. PMC: 2803121. DOI: 10.1378/chest.09-0842. View

16.

Levy A, OBrien B, Sellors C, Grootendorst P, Willison D . Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol. 2003; 10(2):67-71. View

17.

Gueler F, Park J, Rong S, Kirsch T, Lindschau C, Zheng W . Statins attenuate ischemia-reperfusion injury by inducing heme oxygenase-1 in infiltrating macrophages. Am J Pathol. 2007; 170(4):1192-9. PMC: 1829453. DOI: 10.2353/ajpath.2007.060782. View

18.

Law M, Wald N, Rudnicka A . Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003; 326(7404):1423. PMC: 162260. DOI: 10.1136/bmj.326.7404.1423. View

19.

Josephs S, Thakar C . Perioperative risk assessment, prevention, and treatment of acute kidney injury. Int Anesthesiol Clin. 2009; 47(4):89-105. DOI: 10.1097/AIA.0b013e3181b47e98. View

20.

Tu K, Mamdani M, Jacka R, Forde N, Rothwell D, Tu J . The striking effect of the Heart Outcomes Prevention Evaluation (HOPE) on ramipril prescribing in Ontario. CMAJ. 2003; 168(5):553-7. PMC: 149247. View