HMG-CoA reductase inhibitors (statins) and acute kidney injury: A secondary analysis of renal study outcomes.

Acute Kidney Injury / diagnosis Aged Aged, 80 and over Cause of Death Critical Illness Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects Intensive Care Units Male Middle Aged Randomized Controlled Trials as Topic Renal Dialysis / adverse effects Risk Assessment Risk Factors Sepsis / diagnosis Time Factors Treatment Outcome

HMG-COA reductase inhibitors acute kidney injury dialysis mortality sepsis statins

Journal

Nephrology (Carlton, Vic.)

ISSN: 1440-1797

Titre abrégé: Nephrology (Carlton)

Pays: Australia

ID NLM: 9615568

Informations de publication

Date de publication:
Sep 2019

Historique:

accepted: 07 04 2019

pubmed: 7 5 2019

medline: 11 2 2020

entrez: 7 5 2019

Statut: ppublish

Résumé

Mortality in intensive care unit (ICU) patients with acute kidney injury (AKI) remains high. Previous studies have explored the role of HMG-CoA reductase inhibitors (statins) with variable findings. The Randomized Evaluation of Normal versus Augmented Level Replacement Therapy (RENAL) Study recruited 1508 participants requiring dialysis in ICU between 2006 and 2009. Statin use was recorded at study baseline. Multivariate Cox modelling was used to assess associations of such statin use and all-cause mortality. Propensity score analysis was performed for sensitivity analysis. The primary outcome was all-cause mortality at 90 days. Of the 1462 participants with the available data on statin usage, 187 (12.8%) received statin therapy at baseline. Participants who receiving statins were older (P < 0.001), less likely to have sepsis or require mechanical ventilation (P < 0.001). Multivariable analysis showed statin use did not have significant associations with mortality at both day 28 (hazard ratio (HR) = 1.053, 95% confidence interval (CI) = 0.784-1.415, P = 0.730) and day 90 (HR = 1.091, 95% CI = 0.836-1.424, P = 0.520). Propensity score analysis confirmed the lack of association between statin use and mortality at day 90 (HR = 1.042, 95% CI = 0.734-1.479, P = 0.819). However, in septic patients, multivariable analysis suggested statin therapy was associated with a trend to higher mortality at day 90 (HR = 1.688, 95% CI = 1.132-2.519, P = 0.010) and continuation of statins was associated with higher mortality (HR = 2.160, 95% CI = 1.296-3.599, P = 0.003), compared with statin withdrawal. In the RENAL study cohort, baseline statin use was not associated with mortality. Our findings do not support a protective role of statins in ICU patients with severe AKI. Clinical Trials registration number for the RENAL study: NCT00221013, the date of registration: September 14, 2005.

Sections du résumé

BACKGROUND BACKGROUND

Mortality in intensive care unit (ICU) patients with acute kidney injury (AKI) remains high. Previous studies have explored the role of HMG-CoA reductase inhibitors (statins) with variable findings.

METHODS METHODS

The Randomized Evaluation of Normal versus Augmented Level Replacement Therapy (RENAL) Study recruited 1508 participants requiring dialysis in ICU between 2006 and 2009. Statin use was recorded at study baseline. Multivariate Cox modelling was used to assess associations of such statin use and all-cause mortality. Propensity score analysis was performed for sensitivity analysis. The primary outcome was all-cause mortality at 90 days.

RESULTS RESULTS

Of the 1462 participants with the available data on statin usage, 187 (12.8%) received statin therapy at baseline. Participants who receiving statins were older (P < 0.001), less likely to have sepsis or require mechanical ventilation (P < 0.001). Multivariable analysis showed statin use did not have significant associations with mortality at both day 28 (hazard ratio (HR) = 1.053, 95% confidence interval (CI) = 0.784-1.415, P = 0.730) and day 90 (HR = 1.091, 95% CI = 0.836-1.424, P = 0.520). Propensity score analysis confirmed the lack of association between statin use and mortality at day 90 (HR = 1.042, 95% CI = 0.734-1.479, P = 0.819). However, in septic patients, multivariable analysis suggested statin therapy was associated with a trend to higher mortality at day 90 (HR = 1.688, 95% CI = 1.132-2.519, P = 0.010) and continuation of statins was associated with higher mortality (HR = 2.160, 95% CI = 1.296-3.599, P = 0.003), compared with statin withdrawal.

CONCLUSION CONCLUSIONS

In the RENAL study cohort, baseline statin use was not associated with mortality. Our findings do not support a protective role of statins in ICU patients with severe AKI. Clinical Trials registration number for the RENAL study: NCT00221013, the date of registration: September 14, 2005.

Identifiants

DOI: 10.1111/nep.13597 PMID: 31058387

pubmed: 31058387

doi: 10.1111/nep.13597

doi:

Substances chimiques

Hydroxymethylglutaryl-CoA Reductase Inhibitors 0

Banques de données

ClinicalTrials.gov

['NCT00221013']

Types de publication

Comparative Study Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

912-918

Subventions

Organisme : National Heart Foundation

Organisme : ISN funded Fellowship

Investigateurs

Amanda Y Wang (AY)

Konlawij Trongtrakul (K)

Rinaldo Bellomo (R)

Qiang Li (Q)

Alan Cass (A)

Martin Gallagher (M)

Informations de copyright

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