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Two recent studies examined the use of statins in the prevention of CI-AKI patients with CKD. In the first study,514 31 patients were prospectively randomized to receive atorvastatin 80mg/d or placebo for 48 hours before and 48 hours after contrast-medium administration. All patients received i.v. saline and oral NAC. CI-AKI occurred in 16 patients (11%) in the placebo group and 15 patients (10%) in the atorvastatin group. Persistent kidney injury, defined as 1-month increase from baseline creatinine value > 25%, was observed in 30% in the placebo group and in 31% in the atorvastatin group. The second study515 followed 431 patients, 194 of whom were receiving pravastatin treatment for hypercholesterolemia. SCr levels were measured at baseline (preprocedure) and within 48 hours after contrast-medium exposure (peak postprocedure). Logistic regression analysis revealed that pravastatin treatment, preprocedure SCr, and contrast volume were independently related to the decreased risk of CI-AKI. However, such studies are susceptible to the so-called ‘‘healthy user effect’’ where certain groups may have reduced risk, not because of the drug but because of healthier lifestyles, for which use of the medication is a marker. For example, patients taking statins may also be more compliant with other medical-care regimens that may reduce adverse events.
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