Early postoperative statin therapy is associated with a lower incidence of acute kidney injury after cardiac surgery

Abstract

Objective: To test the hypothesis that perioperative statin use reduces acute kidney injury (AKI) after cardiac surgery.

Design: A retrospective analysis of prospectively collected data from an ongoing clinical trial.

Setting: A quaternary-care university hospital.

Participants: Three hundred twenty-four adult elective cardiac surgery patients.

Interventions: None.

Measurements and main results: The authors assessed the association of preoperative statin use, early postoperative statin use, and acute statin withdrawal with the incidence of AKI. Early postoperative statin use was defined as statin treatment within the first postoperative day. Statin withdrawal was defined as the discontinuation of preoperative statin treatment before surgery until at least postoperative day 2. Logistic regression and propensity score modeling were used to control for AKI risk factors. Sixty-eight of 324 patients (21.0%) developed AKI. AKI patients stayed in the hospital longer (p = 0.03) and were more likely to develop pneumonia (p = 0.002) or die (p = 0.001). A higher body mass index (p = 0.003), higher central venous pressure (p = 0.03), and statin withdrawal (27.4 v 14.7%, p = 0.046) were associated with a higher incidence of AKI, whereas early postoperative statin use was protective (12.5% v 23.8%, p = 0.03). Preoperative statin use did not affect the risk of AKI. In multivariate logistic regression, age (p = 0.03), male sex (p = 0.02), body mass index (p < 0.001), and early postoperative statin use (odds ratio = 0.32; 95% confidence interval, 0.14-0.72; p = 0.006) independently predicted AKI. Propensity score-adjusted risk assessment confirmed the association between early postoperative statin use and reduced AKI (odds ratio = 0.30; 95% confidence interval, 0.13-0.70; p = 0.005).

Conclusions: Early postoperative statin use is associated with a lower incidence of AKI among both chronic statin users and statin-naive cardiac surgery patients.

Copyright © 2010 Elsevier Inc. All rights reserved.

Figures

Figure 1

Subject enrollment and study completion.

Figure 2

Incidence of Acute Kidney Injury (AKI) among subjects, separated by statin exposure. Early postoperative statin use was associated with a reduced incidence of AKI among statin-naïve subjects (0% vs. 21%, *, P=0.02) and among preoperative statin-using subjects (14.7 vs. 27.4%, †, P=0.046).