The Preventive Effects Of Intensive Doses Of Atorvastatin On Contrast Induced Nephropathy In Patients Undergoing Percutaneous Coronary Intervention

Objective:To investigate the preventive effects of intensive doses of atorvastatin on contrast induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI) through comparing the changes of renal function.Methods:We selected454patients who were about to undergo PCI in Tianjin Chest Hospital from May2011to December2012in this study. The patients were randomly divided into either intensive group (n=229) or control group (n=225). Both groups received intravenous hydration within12h before and after PCI. Prior to the coronary angiography or angioplasty, patients in the intensive group and control group were given atorvastatin40mg and20mg per day, respectively. Both groups have been used iodixanol as the only contrast agent during the procedure. The levels of blood urea nitrogen, serum creatinine, creatinine clearance rate, estimated glomerular filtration rate, interleukin-6, β2-microglobulin, C-reactive protein, tumor necrosis factor-a, alanine aminotransferase were measured at admission and48-72h after the procedure.Result:1. In the intensive group, only9patients presented with CIN, the incidence of CIN was3.9%; in the control group, CIN occurred in18patients, the incidence of CIN was8.0%(x2=3.361,P＞0.05)2. There were no statistically differences in the levels of BUN, Scr, Ccr, eGFR, P2-MG, CRP, IL-6and TNF-a at admission (P＞0.05).3. The levels of ALT after the procedure were similar (P＞0.05).4. Intensive group (1) There were no significantly differences in the levels of BUN, Scr, Ccr and eGFR (P>0.05) but levels of β2-MG, CRP, IL-6and TNF-a were increased after PCI (P＜0.05or P＜0.01).(2) In the elderly patients sub-group, levels of Scr, β2-MG and CRP were increased (P＜0.05).(3) In the diabetic sub-group, levels of BUN, Scr, Ccr and eGFR were not changed after PCI (P＞0.05), but levels of β2-MG and CRP were increased (P＜0.01).(4) In the chronic renal failure sub-group, the levels of Ccr, eGFR, P2-MG and CRP were increased (P＜0.01). 5. Control group (1) Levels of Scr, β2-MG, CRP, IL-6and TNF-a were increased while levels of Ccr and eGFR were decreased after PCI (P＜0.01or P＜0.05).(2) In the elderly patients sub-group, levels of Scr, β2-MG, CRP, IL-6and TNF-a were increased while Ccr and eGFR levels were decreased (P＜0.01or P<0.05).3) In the diabetic sub-group, levels of BUN were decreased while levels of β2-MG, CRP, IL-6and TNF-a were increased after PCI (P＜0.05or P＜0.01).(4) In the chronic renal failure sub-group, levels of BUN, Scr, Ccr and eGFR were not changed (P＞0.05), but levels of β2-MG, CRP, IL-6and TNF-a were increased after the operation (P＜0.01).6. Intensive group compared to control group (1) Levels of Ccr and eGFR in the intensive group were higher than that of control group when the β2-MG, CRP, IL-6and TNF-a levels were lower in the intensive group (P＜0.05or P＜0.01).(2) In the elderly patients sub-group, there were no differences in the levels of BUN, Scr, Ccr and eGFR between the two groups (P＞0.05) but levels of β2-MG and CRP were lower in the intensive group than in the control group (P＜0.01).(3) In the diabetic sub-group, the Ccr levels were higher, but levels of β2-MG, CRP, IL-6and TNF-a were lower in the intensive group than levels in the control group (P＜0.05or P<0.01).(4) In the chronic renal failure sub-group, there were no differences in the levels of BUN, Scr, Ccr and eGFR between the two group (P＞0.05) but levels of β2-MG and TNF-a were lower in the intensive group (P＜0.05or P<0.01).Conclusion:1. The treatment of intensive atorvastatin before PCI may be beneficial in the prevention of CIN. The protection mechanism may be due to its anti-inflammatory effects.2. The treatment of intensive atorvastatin before PCI may protect the renal function in the elder patients and the patients with diabetic or chronic renal failure.3. The effects of anti-inflammatory may be superior in the intensive treatment group to the conventional treatment group.4. It is safe to use high dose of atorvastatin.