Effect Of Statin Sequential Therapy On Contrast-Induced Nephropathy:a Meta-Analysis

Research backgroundWith continuous development of medical imaging and widely application of percutaneous coronary intervention(PCI), there are continued substantial increases in CIN cases. CIN causes acute or chronic renal failure, as well as higher short-and long-term mortality rates, which seriously affecting the curative effect of PCI. At present,CIN is being called "the third major problem"of PCI following "narrow" and "thrombosis"on account of its unclear nephropathy pathogenesis and very limited prevention measures.Its mechanism is probably ralated to renal medullary ischemia, the toxic effects of contrast medium, oxidative stress, inflammatory response, cell apoptosis, immune response, renal tubular plug, etc, involved in CIN. Statins, selective inhibitors of beta-hydroxy-beta-methyl glutaric acyl coenzyme A (HMG CoA) reductase, in addition to reduce the endogenous cholesterol synthesis, are also known to have pleiotropic functions,such as improving endothelial cell function, stabilizing vulnerable plaques, anti-inflammatory, anti-oxidation, inhibiting of platelet aggregation. As a result, statins are being widely expected to prevent CIN.There are researches back that statin sequential therapy can effectively prevent CIN. But No Clear Conclusion. Whether patients with chronic renal insufficiency can benefit from statins sequential therapy is controversial,and related meta-analysis is few.ObjectiveTo assess the effect of statin sequential therapy on CIN in patients with chronic kedney disease underwent coronary angiography or PCI.MethodsSearched PubMed、OVID、EMBASE、Web of science、CNKI for randomized controlled trial(RCT) from January1966to December2012. Quantified study quality by using the approved Jadad score,then extracted data and entered them into Review manager5.0.Result7RCT with a total of1,420patients were identified and analyzed. Among the7papers,5with high quality,2with low quality, and no heterogeneity exists. All results based on fixed-effect model showed that:(1) to all patients with chronic kedny disease,the use of statin sequential therapy can significantly reduce the incidence of CIN(RR=0.55,95%CI0.39-0.78,P=0.001);(2) the use of statin sequential therapy was associated with a significant reduction in risk of CIN in patients with GFR≥60ml/min(RR=0.29,95%CI0.14-0.57,P=0.0004), but wasn’t in patients with GFR<60ml/min(RR=0.76,95%CI0.50-1.16,P=0.20);(3) As for patients with GFR<60ml/min, both the increase degree of Scr(MD=-0.02,95%CI-0.06-0.02,P=0.39%)and the incidence of acute renal failure requiring RRT(RR=0.19,95%CI0.03-1.07,P=0.06) didn’t significantly reduced after statin sequential therapy. ConclutionStatin sequential therapy can significantly reduce incidence of CIN in patients with normal or mild renal impairment but can’t reduce incidence of CIN in patients with moderate to severe renal impairment. In patients with moderate to severe renal impairment, statin sequential therapy can’t reduce elevated levels of creatinine or reduce incidence of RRT.