Effects of high doses of statins to prevent contrast-induced acute kidney injury, based on cystatin C levels: A meta-analysis

ObjectiveThe potential benefit of measures to prevent contrast-induced acute kidney injury (CIAKI) remains uncertain. This uncertainty is partly due to the reliance on serum creatinine, a biomarker influenced by non-renal factors such as muscle mass, hydration status, and age. Therefore, this study aims to evaluate CIAKI prevention based on cystatin C levels-a more stable and earlier biomarker of renal dysfunction, which may improve diagnostic precision and the assessment of therapeutic efficacy.MethodsWe performed a systematic review and meta-analysis of all randomized clinical trials (RCTs) on preventive measures of contrast-induced acute kidney injury, based on cystatin C levels, in patients who underwent percutaneous procedures. We searched PubMed, Scopus, and Cochrane Central for studies comparing the use of high-dose statins in prevention. The outcome of interest was an acute kidney injury based on increased serum cystatin C after the procedure. Statistical analysis was performed using RevMan 5.4. This systematic review with meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under protocol (CRD42023441815).ResultsWe included four studies with a total of 1167 patients, of whom 594 (50.8%) received high-dose statins (atorvastatin or rosuvastatin). On the baseline characteristics of the study population, 65% were male; 79.2% had hypertension; 44.3% had diabetes; 35.7% had dyslipidemia, and 35.4% were currently smokers. Overall, high doses of statins were associated with a lower incidence the CIAKI (OR 0.31; 95% CI [0.19,0.53]; <i>P</i> < .0001).ConclusionOur findings suggest that high doses of statins may play an important role as a measure to prevent CIAKI. If this result is confirmed, we will be able to set up CIAKI prevention protocols, thus expanding the number of patients who will undergo contrast-enhanced exams.