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 48-72 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 aimed
to evaluate the efficacy of high dose atorvastatin in preventing contrast
induced nephropathy in patients undergoing elective coronary
angiography .
The primary end point of our study was the incidence of CIN
which was defined as rise of serum creatinine by ≥0.5 mg/dl or by a
relative increase of ≥25% over the baseline value in 48 hrs.
The 300 eligible patients were randomized into 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 1 mL/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 (Ultravist).
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 (Cr.CL)
will be calculated according to Cockcroft formula .
Also, Complete blood count and Liver enzymes were measured
before the procedure.
The baseline clinical and biochemical characteristics, serum
creatinine, e GFR , and amount of intravenous fluids and contrast were
similar between both groups.
There was no statistically significant difference between both
groups as regarding age & gender distribution , BMI , risk factor
distribution e.g Diabetes mellitus , HTN , Anemia , CKD , CHF .
The incidence of CIN in our study population was 14.7% ( 44 patients
out of 300), The incidence of CIN in the placebo group was 20% ( 30
patients out of 150) while the incidence of CIN in the Atorvastatin group
was 9.3% ( 14 patients out of 150). ( P value = 0.009)
The study results showed 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 an additional preventive effect over the standard
measures against CIN in statin naïve patients with moderate & high risk
for CIN undergoing elective coronary angiography .
In our study, Incidence of CIN among high risk patients was 61.1%
in the placebo group ( 22 patient) , and 25% in the Atorvastatin group (
8 patient), with statistically significant difference ( P value= 0.03 )
indicating that Atorvastatin has a protective effect against CIN in high
risk group . , while Incidence of CIN among moderate risk patients was
7% in the placebo group ( 8 patients) , and 5.1 % in the Atorvastatin
group ( 6 patients) , with no statistically significant difference ( P value =
0.59 ) indicating that Atorvastatin has no a significant protective effect
against CIN in moderate risk group but there is a trend toward decreasing
the incidence of CIN .
The incidence of CIN among diabetics in the placebo group was
25% ( 27 patients out of 108 ) , while the incidence among diabetics in
the Atorvastatin group was 11.4% ( 13 patients out of 114 ) , with
statistically significant difference ( P value = 0.008) .
The incidence of CIN among hypertensive patients in the placebo
group was 26.8% ( 22 patients out of 82 ) , while the incidence among
hypertensive patients in the Atorvastatin group was 9.6% ( 8 patients out
of 83 ) , with statistically significant difference ( P value = 0.007) .
The incidence of CIN among those with CHF in the placebo group
was 26.8% ( 22 patients out of 82 ) , while the incidence among those
with CHF in the Atorvastatin group was 14.8% ( 12 patients out of 81 ) ,
with no statistically significant difference ( P value= 0.06) . but there was
a trend toward more incidence in the placebo group .
The incidence of CIN among those with baseline IKF in the
placebo group was 40% ( 12 patients out of 30) , while the incidence
among those with baseline IKF in the Atorvastatin group was 14.8% ( 4
patients out of 27 ) , with statistically significant difference ( P value=
0.03) .
The incidence of CIN among those with anemia in the placebo
group was 26.7% ( 16 patients out of 60 ) , while the incidence among
those with anemia in the Atorvastatin group was 13.7% ( 7 patients out of
51 ) , with no statistically significant difference ( P value = 0.09) . but
there was a trend toward more incidence in the placebo group .