Statins and Contrast-Induced Nephropathy

There is an amazing amount of focus in the cardiology literature on the issue of contrast-induced nephropathy (CIN) with intra-arterially injected iodinated contrast media.

This week’s issue of JACC (Journal of American College of Cardiology) has two articles on the use of statins (in this case, specifically, rosuvastatin) that reduces the risk of CIN in high-risk patients undergoing catheter coronary angiography. The first article by Han et al has a larger group of patients who are diabetic and have mild to moderate CKD whereas the second article by Lencioni M et al has a smaller group of patients who presented predominantly with non-ST segment acute coronary syndrome.

In both articles, the patients were well-hydrated. Both have a control group that did not receive statins and both articles unequivocally show a reduction in the incidence of CIN.

Whether this is applicable to patients undergoing contrast administration during computed tomography is uncertain.

The overall incidence of CIN in practice is low and if we stick to the basic principles of evaluating the renal function in those at risk and using hydration and low-ionic contrast media, we can pretty much reduce the risk considerably. It is a good idea to re-evaluate all of this by going through the 2013 edition of the ACR criteria and a lovely review article by a Jorgensen Ann, a nurse. Many of us also use acetyl-cysteine, but the data regarding its efficacy is not very robust.

As usual, if you need copies of the JACC articles for personal perusal, send me a request.

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