الفهرس 
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Abstract
Contrast-induced nephropathy has become a significant source of hospital morbidity and mortality , It is the third most common cause of hospital-acquired acute renal failure, after surgery and hypotension.
Contrast-induced nephropathy has become most commonly defined as ”a 25% increase in serum creatinine concentration from the baseline value, or an absolute increase of at least 0.5 mg/dL (44.2 µmole/L), which appears within 48 hours after the administration of radiographic contrast media, and is maintained for 2–5 days”.
The large number of patients who are affected by CIN underscores the importance of addressing known risk factors and preventions of CIN.After the high risk patient population has been identified and risk factors addressed , the next step in preventing CIN is the use of different prophylactic therapies.
Despite many interventions that have been tried, controversy remains regarding the efficacy of interventions for CIN.
Our study is a prospective randomized controlled study that aims to evaluate the efficacy of high dose atorvastatin in preventing contrast induced nephropathy in patients undergoing coronary angiography or percutaneous coronary intervention.
The primary end point of our study was the incidence of CIN which was defined asrise of serum creatinine greater than 0.5 mg/dl or by a relative increase of 25% over the baseline value in 48 hrs.
The 80 eligible patients were randomized into one of two groups: Atorvastatin group who received 80 mg atorvastatin, 12 hours before the procedure, with a further 40 mg pre-procedural dose, and placebo group who didn’t receive loading dose of atorvastatin.
Both groups received adequate hydration with 1mL/Kg/hr normal saline 12 hours before the procedure and up to 12 hours after the procedure. (Hydration rate was reduced to 0.5 ml/kg/hr for patients with left ventricular ejection fraction < 40% or New York Heart Association functional class III-IV).
Also both groups received N-acetylcysteine (NAC) (600 mg twice daily) on the day before and the day of administering contrast media.
All patients received the same type of contrast medium, containing low osmolality non-ionic contrast agent, iopamidol (Scanlux).
All patients were interviewed to answer the study questionnaire including age, history of smoking , chronic diseases ; diabetes, hypertension, chronic liver and chronic renal disease, history of ischemic heart disease was taken in details, the main cardiac symptoms including heart failure symptoms in addition to drug history.
Samples were withdrawn for serum creatinine prior to the procedure and two days after the procedure. Creatinine clearance (CrCL) will be calculated according to Cockcroft formula and Levey Modified Diet for Renal Disaese (MDRD) formula.
Also, Complete blood count ,Fasting lipid profile and Liver enzymes were measured before the procedure.
In the placebo group ( 30 out of 40 patients ) were on chronic statin therapy , while in the Atorvastatin group ( 35 out of 40 patients ) were on chronic statin therapy.
The baseline clinical and biochemical characteristics, serum creatinine, e GFR , and amount of intravenous fluids and contrast were similar between both groups.
The incidence of CIN in our study population was 16.2% ( 13 patients out of 80), The incidence of CIN in the placebo group was 20% ( 8 patients out of 40) while the incidence of CIAKI in the Atorvastatin group was 12.5% ( 5 patients out of 40). ( P value = 0.363)
The study results showed no statistically significant difference between both groups, the placebo group and Atorvastatin group regarding the incidence of CIN, which means that short term high loading dose of Atorvastatin had no additional benefit over long term statin therapy in prevention of CIN incidence.