High-Dose Atorvastatin For Contrast-Induced Acute Kidney Injury Prevention

Objective: Studies suggest that statins might exert a protective effect against acute kidney injury(AKI),but most of the studies currently evaluate the change of renal function by monitoring serum creatinine(sCr),there are few studies on the assessment from novel renal injury biomarkers.We probed the changes in sCr and novel renal injury biomarkers before and after percutaneous coronary intervention(PCI)in an effort to observe the protective effect of high-dose atorvastatin.Methods: We conducted a prospective,randomized,controlled study,involving 210 acute coronary syndrome patients.Patients were randomly assigned to receive high-dose atorvastatin(80 mg on the day before PCI,followed by 40 mg/day for three consecutive days;statin group n = 105)or conventional-dose atorvastatin(20 mg on the day before PCI,followed by 20 mg/day for three consecutive days;n = 105).Serum creatinine(SCr)was measured before and 24 h,48 h after PCI.27 patients older than 60(including 60 years old)were randomly selected from both groups,urinary liver-type fatty acid-binding protein(uL-FABP)?urinary neutrophil gelatinase-associated lipocalin(uNGAL)and urinary kidney injury molecule-1(uKIM-1)were measured by enzymelinked immunosorbent assay before and 6 h,24 h,48 h after PCI.AKI is defined as an increase in SCr level of greater than 26.5?mol/L within 48 h after PCI.Results: AKI occurred in 17 patients(8.1%),10 patients in the conventional-dose atorvastatin group and 7 patients in the high-dose atorvastatin group.The relative measurement of sCr was significantly different between the two groups(24h after PCI:1.07±0.17 in conventional-dose atorvastatin group VS.0.98±0.20 in high-dose atorvastatin group,P=0.001;48h after PCI: 1.09±0.23 in conventional-dose atorvastatin group VS.1.00±0.20 in high-dose atorvastatin group,P=0.006).The relative measurement of uL-FABP was significantly lower in the high-dose atorvastatin group at 48 h after PCI[1.03(0.73 ~ 1.34)VS.1.64(0.98 ~ 3.58),P=0.042].uNGAL and uKIM-1 levels were not significantly different between the two groups.Conclusion: Compared with conventional-dose atorvastatin treatment,high-dose atorvastatin therapy can improve the severity of kidney injury in patients with acute coronary syndrome undergoing PCI.