Date of Graduation

8-13-2016

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Jennifer VanAtta PA-C

Abstract

Background: Contrast-induced nephropathy (CIN) is a serious adverse event that certain patients experience as a result of a radiologic study performed with intravascular contrast media. The most at risk population includes patients with preexisting renal impairment. Due to the lack of successful treatment for contrast-induced nephropathy and its potentially critical results, preventative strategies are imperative. Though many approaches have been implemented, no universal standard protocol currently exists for the prevention of CIN in at-risk patients. Recent research has demonstrated controversial results of the use of short-term statin therapy for prevention of CIN. The aim of this systematic review is to evaluate the efficacy of atorvastatin in prevention of CIN in patients with renal impairment undergoing coronary angiography or percutaneous coronary intervention.

Methods: An exhaustive search of available medical literature from MEDLINE-Ovid, MEDLINE-PubMed, and Google Scholar was performed using the search terms “contrast-induced nephropathy,” “acute kidney injury,” “statins,” “atorvastatin,” “HMG-CoA reductase inhibitors.” Studies were excluded if they were not written in the English language, did not have human subjects, included patients without renal impairment, were not randomized control trials, or were published more than eight years ago.

Results: Quintavalle et al9 performed a randomized control trial evaluating a single 80mg dose of atorvastatin 24 hours before percutaneous coronary intervention (PCI) or coronary angiography (CAG) vs placebo. Results demonstrated incidence of CIN in 9 of 202 patients (4.5%) in the atorvastatin group and in 37 of 208 patients (17.8%) in the control group. Shehata and Hamza10 also performed a double-blind randomized control trial evaluating the use of 80mg daily of atorvastatin vs placebo for 48 hours prior to PCI. The incidence of CIN was 5 of 65 patients (7.7%) in the atorvastatin group compared to 13 of 65 patients (20%) in the control group.

Conclusion: As demonstrated by both studies, a high loading dose of atorvastatin is significantly efficacious in reducing the incidence of contrast-induced nephropathy in patients with mild to moderate chronic kidney disease undergoing PCI or CAG.

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