Rosuvastatin Effect On Prevention Of Contrast-induced Acute Kidney Injury In Patients With Diabetes And Chronic Kidney Disease Combined With Diuretic Therapy

Objective：Contrast-induced acute kidney injury (CIAKI) is a major complication aftercontrast media injection. It is defined as an increase in baseline serum creatinine level of25%or an absolute increase of44mmol/L (0.5mg/dL). It is associated with lengthenedhospital stays, increased health care costs, and higher risk of death. The aim of thisstudy was to evaluate the safety and efficacy of rosuvastatin in preventing contrastinduced acute kidney injury (CIAKI) in patients with diabetes mellitus (DM) andchronic kidney disease (CKD) who all received the furosemide according the clinician.Methods: The TRACK-D (Rosuvastatin Prevent Contrast Induced Acute Kidney Injuryin Patients With Diabetes) study led by Han Yaling academician, was an investigator-initiated, prospective, randomized, controlled, multicenter clinical trial.2,998patientswith type2DM and concomitant CKD who were undergoing coronary/peripheralarterial angiography were selected at the General Hospital of Shenyang Military Regionwith other53centers together. Patients were randomized to receive eitherrosuvastatin10mg every evening, from2days before to3days after contrast mediumadministration or to a control group. Patients assigned to the control group did notreceive any statins. This study was the subgroup analysis of the TRACK-D and sixhundred and fifty patients received furosemide were selected including rosuvastatin group (n=321), or control group(n=329). This study was approved by the ShenyangGeneral Hospital Ethics Committee and written informed consent was obtained fromeach patient. According to the study design, blood samples were taken to measure SCrconcentrations before randomization, at48and72hours after contrast mediumadministration.The primary end-point was the occurrence of CIAKI, defined as an increase inserum creatinine≥0.5mg/dL (44.2μmol/L) or≥25%above baseline at72h afterexposure to contrast medium. Secondary endpoints:30-day composite end pointincluding NYHA class on admission to deteriorate more than one, all-cause mortality,requiring dialysis or hemofiltration.Results:(1) Among2998patients of the TRACK-D study,650patients receivedfurosemide and2348didn’t receive. Baseline data including the ages, congestive heartfailure, anemia, diabetes mellitus,SCr and eGFR were similar between the two groups(P＜0.01).(2) The incidence of CIAKI was significantly higher in the patients whoreceived furosemide than the non-furosemide. The incidence of CIAKI in rosuvastatingroup, the control group and the TRACK-D group were [5.0%(16/321) vs1.5%(18/1177)，P＜0.001]、[9.7%(32/329) vs2.2%(26/1171)，P＜0.001]and [7.4%(48/650) vs1.9%(44/2348)，P＜0.001];(3)All the650patients who received furosemide wererandomized to the rosuvastatin group (321cases) and the control group (329cases), thebaseline datas were similar between the two groups.(4) Rosuvastatin and the controlgroup had a significantly lower incidence of CIAKI compared with controls (5.0%vs.9.7%, P=0.024).(5) The30-day incidence of death, dialysis, or worsing heart failurewas not significant between the rosuvastatin group and the control group.Conclusion:(1) Furosemide aggravated contrast-induced acute kidney injury;(2)Rosuvastatin significantly reduced the risk of CIAKI in patients with DM and CKDwho all received the furosemide and improved short-term clinical outcome.