A pilot double-blind, randomized controlled trial of short-term atorvastatin for prevention of acute kidney injury after cardiac surgery.
Author(s): Prowle JR, Calzavacca P, Licari E, Ligabo EV, Echeverri JE, Haase M, Haase-Fielitz A, Bagshaw SM, Devarajan P, Bellomo R
Affiliation(s): Department of Intensive Care, Austin Health, Melbourne, Australia. Intensive Care Unit, Royal London Hospital, Barts & The London NHS Trust, London, UK. Department of Nephrology and Hypertension & Endocrinology and Metabolic Diseases, Otto-von-Guericke-University, Magdeburg, Germany. Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada. Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Publication date & source: 2011-11-24, Nephrology (Carlton)., [Epub ahead of print]
Aim: To test whether short term peri-operative administration of oral atorvastatin could reduce incidence of post-operative acute kidney injury (AKI) in cardiac surgical patients. Methods: we conducted a double-blind, randomized controlled trial in 100 cardiac surgical patients at increased risk of postoperative AKI. Patients were randomized to atorvastatin (40 mg once daily for 4 days starting pre-operatively) or identical placebo capsule. Primary outcome was to detect a smaller absolute rise in post-operative creatinine with statin therapy. Secondary outcomes included AKI defined by the creatinine criteria of RIFLE consensus classification (RIFLE R, I or F), change in urinary neutrophil gelatinase-associated lipocalin (NGAL) concentration, requirement for renal replacement therapy, length of stay in intensive care, length of stay in hospital and hospital-mortality. Results: Study groups were well matched. For each patient maximal increase in creatinine during the 5 days after surgery was assessed; median maximal increase was 28 micromol/L in the atorvastatin group and 29.5 micromol/L in the placebo group (p = 0.62). RIFLE R or greater occurred in 26% of patients with atorvastatin and 32% with placebo (p = 0.65). Post-operatively urine neutrophil gelatinase associated lipocalin (NGAL) changes were similar (Median NGAL:Creat ratio at ICU admission: atorvastatin group 1503 ng/mg, placebo group 1101 ng/mg, p = 0.22). Treatment was well tolerated and adverse events were similar between groups. Conclusions: Short-term peri-operative atorvastatin use was not associated with a reduced incidence of post-operative AKI or smaller increases in urinary NGAL. (ClinicalTrials.gov NCT00910221). (c) 2011 The Authors. Nephrology (c) 2011 Asian Pacific Society of Nephrology.