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Abstract: SA-PO088

Atorvastatin and Renoprotective Effects for Contrast-Induced NephropAthy Prevention (ARENA): A Pilot Feasibility Randomized Controlled Trial

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Phannajit, Jeerath, Division of Clinical Epidemiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
  • Lumlertgul, Nuttha, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Srisawat, Nattachai, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Susantitaphong, Paweena, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Katavetin, Pisut, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background

Contrast-induced acute kidney injury (CI-AKI) can complicate coronary angiography (CAG) that can lead to increased morbidity and mortality. Previous studies have shown the protective effects of high-dose statin pretreatment in various scenarios. However, the role of statins in preventing subclinical AKI is still under investigation.

Methods

We conducted a randomized controlled trial including 50 patients at stage G3-4, who were randomly assigned to receive either 80 mg of atorvastatin or placebo once daily for 2 days prior to undergoing CAG. The primary outcome was the change in urine NGAL concentration 6 hours after CAG compared to baseline. Secondary outcomes included the incidence of AKI based on serum creatinine criteria, changes in estimated glomerular filtration rate (eGFR) from baseline to 7 days after the procedure, and the occurrence of adverse events such as hepatitis and myositis. Additionally, an in-vitro study was conducted to explore the effect of radiocontrast on NGAL assay.

Results

The mean baseline eGFR was 53.4 ± 17.8 ml/min/1.73m2, and 22 patients (44%) had not previously used statins. Percutaneous coronary intervention was performed in 19.1% of patients, and all participants received iso-osmolar contrast with a median volume of 37.5 [30-80] ml. There were no significant differences observed in urine NGAL concentrations 6 hours after CAG between the atorvastatin and placebo groups (median [IQR] 4.4 [2.8-18.1] vs 6.6 [2.4-13.0], p = 0.9). The analysis also revealed no significant interaction with prior statin use, and no cases of CI-AKI were identified based on serum creatinine criteria. No adverse events were reported, and there were no significant increases in transaminase and creatine phosphokinase enzymes. The additional in-vitro study demonstrated no assay interference of radiocontrast in measuring urine NGAL.

Conclusion

The administration of high-dose atorvastatin as pretreatment of CAG was well tolerated in this study involving patients with early CKD and low-volume iso-osmolar contrast. However, the study did not demonstrate a renoprotective effect in this population, indicating a limited benefit for atorvastatin in this low-risk setting.

Funding

  • Government Support – Non-U.S.