Prevention of periprocedural kidney ingury by loading doses of statins in elective percutaneous œronary interventions

Purpose of the study. To compare the effect of loading doses of atorvastatin and rosuvastatin on the value of the acute kidney injury and acute inflammatory response to elective percutaneous coronary interventions. Materials and methods. An open prospective comparative study included 68 patients referred for elective percutaneous coronary intervention (PCI). At baseline, all patients had been taking statins for a long time as a standard lipid-lowering therapy. The first group included 33 patients who received a loading dose of 80 mg of atorvastatin (As) 12 hours before the intervention with saving this dose for 2-6 days. The second group included 35 patients treated with rosuvastatin (Rs) 40 mg/day in the same manner. The levels of creatinine and cystatin C in the blood were determined at baseline and 12, 24, 48 and 72 hours after the intervention. HsCRP level was determined at baseline and 72 hours after PCI. Results. AKI was diagnosed in 5 patients (7.94%): 4 patients (12.1%) in group As and 1 patient (3.3%) in group Rs (p = 0.36). The increase of serum creatinine level in the group As patients was 43.4% higher than one in the Rs group patients (p = 0.024). The decrease of glomerular filtration rate (GFR) in group As was 15.5% higher than one in group Rs (p = 0.09). Initially, the level of cystatin C in the groups did not differ (698.9 (560.2-869.6) ng/ml in group As vs 759.5 (673.8-899.9) ng/ml in group Rs, p = 0.75). Significant intergroup differences were found in the level of serum cystatin C 12 hours after PCI (718.3 (555.6-839.6) ng/ml in group As vs 470.6 (378.2-689.4) ng/ml in the Rs group, p = 0.007) that persisted 24 hours after the intervention (732.1 (632.3-887) ng/ml vs 526.4 (357.4-802.7) ng/ml, respectively, p = 0.02). From the second day after PCI, intergroup differences in serum cystatin C disappeared. The level of hsCRP significantly increased 72 hours after the intervention in group As (1.65 (0.9-4) mg/l at baseline vs 4.55 (1.6-8.7) mg/l 72 hours after PCI, p = 0.01). The level of hsCRP did not change significantly at the same time in the Rs group (2.8 (0.8-6.8) mg/l at baseline vs 2.75 (1.5-6.5) mg/l 72 hours after PCI, p = 0.16). Conclusion. The loading dose of rosuvastatin better prevents periprocedural kidney injury in PCI and more significantly reduces the overall inflammatory response to intervention compared to the loading dose of atorvastatin.

стабильная стенокардия, чрескожное коронарное вмешательство, статины, острое повреждение почек, stable angina, transcutaneous coronary intervention, statins, acute kidney injury

1. Вершинина Е. О., Репин А. Н. Контраст-индуцированная нефропатия при плановых эндоваскулярных вмешательствах на коронарных артериях. Сибирский медицинский журнал (г. Томск). 2016,31 (3):61-7.

2. Amin A.P. Trends in the Incidence of Acute Kidney Injury in Patients Hospitalized With Acute Myocardial Infarction. Archives of Internal Medicine. 2012,172 (3):246. DOI:10.1001/archinternmed. 2011.1202

3. Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME et al. Contemporary Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions. JACC: Cardiovascular Interventions. 2014,7 (1):1-9. DOI:10.1016/j. jcin. 2013.06.016

4. Вершинина Е. О., Репин А. Н. Острое перипроцедурное повреждение почек при плановых чрескожных коронарных вмешательствах. Евразийский кардиологический журнал. 2017; (3):114.

5. Solomon R. Forced diuresis with the RenalGuard system: Impact on contrast induced acute kidney injury. Journal of Cardiology. 2014,63 (1):9-13. DOI:10.1016/j. jjcc. 2013.10.001

6. Parving H-H, Brenner BM, McMurray JJV, de Zeeuw D., Haffner SM, Solomon SD et al. Cardiorenal End Points in a Trial ofAliskiren for Type 2 Diabetes. New England Journal of Medicine. 2012,367 (23):2204-13. DOI:10.1056/NEJMoa1208799

7. Liao J.K. Isoprenoids as mediators of the biological effects of statins. Journal of Clinical Investigation. 2002,110 (3):285-8. DOI:10.1172/JCI16421

8. Sidaway JE. Inhibitors of 3-Hydroxy-3-Methylglutaryl-CoA Reductase Reduce Receptor-Mediated Endocytosis in Opossum Kidney Cells. Journal of the American Society of Nephrology. 2004,15 (9):2258 65. DOI:10.1097/01. ASN. 0000138236.82706. EE

9. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H et al. 2016 ESC/EAS Guidelines for the Management of Dyslip idaemias. Eur Heart J. 2016,37 (39):2999-3058. DOI:10.1093/eurheartj/ehw272

10. ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. European Heart Journal. 2013,34 (38):2949-3003. DOI:10.1093/eurheartj/eht296

11. Pokazaniia k revaskuliarizatsii: (rossiiskii soglasitel'nyi dokument). -Moskva: Nauchnyi tsentr serdechno-sosudistoi khirurgii im. A. N. Bakuleva RAMN; 2011. ISBN: 978-5-7982-0288-1

12. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention. Journal of the American College of Cardiology. 2004,44 (7):1393-9. DOI:10.1016/j. jacc. 2004.06.068

13. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004,8 (4):R204-212. DOI:10.1186/cc2872

14. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care. 2007,11 (2):R31. DOI:10.1186/cc5713

15. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), European Association for Percutaneous Cardiovascular Interventions (EAPCI), Wijns W, Kolh P, Danchin N, Di Mario C et al. Guidelines on myocardial revascularization. Eur Heart J. 2010.31 (20):2501-55. DOI:10.1093/eurheartj/ehq277

16. Attallah N, Yassine L, Musial J, Yee J, Fisher K. The potential role of statins in contrast nephropathy. Clin Nephrol. 2004,62 (4):273-8. PMID:15524057

17. Khanal S, Attallah N, Smith DE, Kline-Rogers E, Share D, O'Donnell MJ et al. Statin therapy reduces contrast-induced nephropathy: An analysis of contemporary percutaneous interventions. The American Journal of Medicine. 2005,118 (8):843-9. DOI:10.1016/j. amjmed. 2005.03.031

18. Li Y., Liu Y., Fu L., Mei C., Dai B. Efficacy of Short-Term High-Dose Statin in Preventing Contrast-Induced Nephropathy: AMeta-Analysis of Seven Randomized Controlled Trials. Ashton N., редактор. PLoS ONE. 2012; 7 (4):e34450. DOI: 10.1371/journal, pone. 0034450

19. Leoncini M., Toso A., Maioli M., Tropeano F., Villani S., Bellandi F. Early High-Dose Rosuvastatin for Contrast-Induced Nephropathy Prevention in Acute Coronary Syndrome. Journal of the American College of Cardiology. 2014;63(l):71-9.DOI:10.1016/j. jacc. 2013.04.105

20. Han Y., Zhu G., Han L., Hou F., Huang W., Liu H. et al. Short-Term Rosuvastatin Therapy for Prevention of Contrast-Induced Acute Kidney Injury in Patients With Diabetes and Chronic Kidney Disease. Journal of the American College of Cardiology. 2014;63 (l):62-70. DOI:10.1016/j. jacc. 2013.09.017

21. Marenzi G., Cosentino N., Werba JP, Tedesco CC, Veglia F., Bartorelh AL. A meta-analysis of randomized controlled trials on statins for the prevention of contrast-induced acute kidney injury in patients with and without acute coronary syndromes. International journal of Cardiology. 2015;183:47-53. DOI:10.1016/j. ijcard. 2015.01.046

22. Giacoppo D., Capodanno D., Capranzano P., ArutaP, Tamburino C. Meta-Analysis of Randomized Controlled Trials of Preprocedural Statin Administration for Reducing Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Catheterization. The American Journal of Cardiology. 2014;114 (4):541-8. DOI:10.1016/j. amjcard. 2014.05.036

23. UkaigweA, Karmacharya P, Mahmood M, PathakR, Aryal MR, Jalota L et al. Meta-Analysis on Efficacy of Statins for Prevention of Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Angiography. The American Journal of Cardiology. 2014; 114 (9):1295-302. DOI:10.1016/j. amjcard. 2014.07.059

24. Briasoulis A, Mallikethi-Reddy S, Sharma S, Briasouli AA, Afonso L. 3-Hydroxy-3-Methylglutaryl-CoA Reductase Enzyme Inhibitors for Prevention of Contrast-Induced Nephropathy: A Meta-Analysis of Prospective Randomized Controlled Studies. American Journal of Therapeutics. 2015;22 (6):el58-66. DOL10.1097/MJT. 0000000000000126

25. Liu Y, Liu Y, Duan C, Tan N, Chen J, Zhou Y et al. Statins for the Prevention of Contrast-Induced Nephropathy After Coronary Angiography/Percutaneous Interventions: AMeta-analysis of Randomized Controlled Trials. Journal of Cardiovascular Pharmacology and Therapeutics. 2015;20 (2) : 181-92. DOI: 10.1177/1074248414549462

26. Lee JM, Park J, Jeon K-H, Jung J, Lee SE, Han J-K et al. Efficacy of Short-Term High-Dose Statin Pretreatment in Prevention of Contrast-Induced Acute Kidney Injury: Updated Study-Level Meta-Analysis of 13 Randomized Controlled Trials. Remuzzi G, редактор. PLoS ONE. 2014;9 ( 11 ):el 11397. DOI:10.1371/journal. pone. 0111397

27. Toso A, Leoncini M, Maioli M, Tropeano F, Di Vincenzo E, Villani S, et al. Relationship Between Inflammation and Benefits of Early High-Dose Rosuvastatin on Contrast-Induced Nephropathyin Patients With Acute Coronary Syndrome. JACC: Cardiovascular Interventions. 2014;7 (12): 1421-9. DOI:10.1016/j. jcin. 2014.06.023

28. Jian-Wei Z, Yu-Jie Z, Shu-Jun C, Qing Y, Shi-Wei Y, Bin N. Impact of Preprocedural High-Sensitivity С-Reactive Protein on Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention. Angiology. 2014;65 (5):402-7. DOI: 10.1177/0003319713482177

29. DavignonJ. Beneficial Cardiovascular Pleiotropic Effects of Statins. Circulation. 2004; 109 (23_suppl_l):III-39-III - 43. DOL10.1161/01. CIR. 0000131517.20177.5a

30. Chyou AC, Thodge A, Feldman DN, Swaminathan RV. Statins in the Prevention of Contrast-Induced Nephropathy. Current Treatment Options in Cardiovascular Medicine [Интернет]. 2015 [цитируется по 18 апрель 2018 г.];17 (4). D01:10.1007/sll936-015-0375-0

31. Wang X, Zhang T, Hu L, Sun S, Zhang W, Sun Z et al. Comparison of Effects of Different Statins on Contrast-Induced Acute Kidney Injury in Rats: Histopathological and Biochemical Findings. Oxidative Medicine and Cellular Longevity. 2017;2017:1-10. DOL10.1155/2017/6282486