Statins May Lower Post-op AKI Risk

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MONTREAL—Statin use is associated with a decreased risk of acute kidney injury (AKI) after major elective surgery, according to a large retrospective cohort study that utilized multiple healthcare databases in Ontario, Canada.

Amber Molnar, MD, a resident at the University of Western Ontario, London, presented study findings at the Canadian Society of Nephrology annual meeting. She and her co-investigators used data from the Ontario Drug Benefit Plan to determine statin use.

The plan contains information on all outpatient prescriptions dispensed to Ontario residents aged 65 years and older. The study included 219,524 patients who underwent major elective surgery from 1995 to 2008; 70,485 were statin users. All subjects who received dialysis or a kidney transplant in the three years prior to surgery were excluded.

Overall, after adjustment for patient and surgical characteristics, preoperative statin use was associated with less AKI (determined by administrative codes) and less acute dialysis. Statin use for 30 to 90 days prior to surgery and less than 30 days prior to surgery both associated with less AKI.

The researchers observed that the protective effect of statins did not differ between those with and without chronic kidney disease and did not differ across eras (1995-1999, 2000-2004, and 2005-2008).

“We conclude from the results that statins may be protective against perioperative AKI, however, more evidence is needed.,” Dr. Molnar told Renal & Urology News.

Statins have been shown to have anti-inflammatory and immunomodulatory effects and improve endothelial function, she explained. They have also been found to be renoprotective in several animal studies.

Commenting on the findings, Brian Stephany, MD, an associate staff member in the Department of Nephrology and Hypertension at the Cleveland Clinic's Glickman Urologic and Kidney Institute, observed: “Over the last 30 to 40 years several interventions have been tested to reduce post-operative acute kidney injury, and nothing's been shown to prevent it. Who knows, we may have something here that actually does work.”

Statins have a solid safety track record, he noted. Hence, their inclusion in a pre-operative regimen may indeed be beneficial, if other research corroborates the new findings.

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