PREOPERATIVE STATIN THERAPY IN CARDIAC SURGERY AND ACUTE KIDNEY INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL TRIALS

Acute kidney injury (AKI) following cardiac surgery occurs in 30% of cases with 1% requiring dialysis resulting in significant morbidity and mortality.  HMG-CoA Reductase Inhibitors (“statins”) have been postulated to be of benefit in this population, however results from existing clinical studies have been inconsistent. Since there is abundance of evidence showing that short-term pleotropic effects of statins are usually seen after 2 weeks’ time, we sought to perform a systematic review and meta-analysis on the efficacy of preoperative statins in preventing AKI in patients undergoing cardiac surgery.

Results:

In 4 RCTs and 22 observational studies involving 44,773 patients, the incidence of AKI in the statin vs. control group was 18.54% (4425/23872) vs. 20.74% (4335/20901), (OR 0.87; 95% CI 0.80-0.95, I2 = 33%, p= 0.002). Subgroup analysis of randomized controlled trials only also showed a similar trend, 16.15% (47/291) vs. 19.52% (57/292), (RR 0.85; 95% CI 0.60-1.20, I2 = 0%, p= 0.35).

Conclusions:

Patients undergoing cardiac surgery might benefit from preoperative statin therapy in reducing the incidence of postoperative AKI. Providing adequate preoperative exposure time (at least >2 weeks) for the elective cardiac surgeries might be warranted to see optimal effect. The same dosing strategy as for percutaneous coronary intervention (PCI) i.e. 24-48 hours of preoperative statin therapy, might not work as the pathophysiology of AKI seems to be multifactorial here as opposed to contrast induced for PCI.