Perioperative Statins Do Not Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Objectives To evaluate whether perioperative statins reduce the risk of acute kidney injury (AKI) after cardiac surgery. Design Systematic review and meta-analysis of randomized trials. Setting Perioperative management in hospitals that perform cardiac surgery. Participants Adult patients undergoing cardiac surgery. Interventions PubMed, EMBASE, and the Cochrane Library databases were searched for randomized trials. Random-effects meta-analyses were performed to compare the effects of statins versus placebo/control. Trial sequential analysis was conducted to confirm the results. Measurements and Main Results The primary outcome was incidence of postoperative AKI. Eight trials enrolling 3,204 patients were included. The statin arms and the control arms were comparable in incidence of postoperative AKI (risk ratio [RR] = 1.02, 95% confidence interval [CI] = 0.82-1.28), need for renal replacement therapy (RR = 1.09, 95% CI = 0.45-2.66), mechanical ventilation duration (mean difference [MD] = 24.84 min, 95% CI = −55.53-105.20), intensive care unit length of stay (MD = 0.04 days, 95% CI = −3.13-3.20), hospital length of stay (MD = −0.08 days, 95% CI = −0.31-0.15), and in-hospital mortality (RR = 3.76, 95% CI = 0.93-15.14). Trial sequential analysis confirmed that it is unlikely that perioperative statin therapy could achieve a 20% or more relative risk reduction in AKI incidence. Conclusions Among patients undergoing cardiac surgery, perioperative statin treatment did not reduce the risk of AKI. Statin therapy should not be initiated to prevent AKI following cardiac surgery. To evaluate whether perioperative statins reduce the risk of acute kidney injury (AKI) after cardiac surgery. Systematic review and meta-analysis of randomized trials. Perioperative management in hospitals that perform cardiac surgery. Adult patients undergoing cardiac surgery. PubMed, EMBASE, and the Cochrane Library databases were searched for randomized trials. Random-effects meta-analyses were performed to compare the effects of statins versus placebo/control. Trial sequential analysis was conducted to confirm the results. The primary outcome was incidence of postoperative AKI. Eight trials enrolling 3,204 patients were included. The statin arms and the control arms were comparable in incidence of postoperative AKI (risk ratio [RR] = 1.02, 95% confidence interval [CI] = 0.82-1.28), need for renal replacement therapy (RR = 1.09, 95% CI = 0.45-2.66), mechanical ventilation duration (mean difference [MD] = 24.84 min, 95% CI = −55.53-105.20), intensive care unit length of stay (MD = 0.04 days, 95% CI = −3.13-3.20), hospital length of stay (MD = −0.08 days, 95% CI = −0.31-0.15), and in-hospital mortality (RR = 3.76, 95% CI = 0.93-15.14). Trial sequential analysis confirmed that it is unlikely that perioperative statin therapy could achieve a 20% or more relative risk reduction in AKI incidence. Among patients undergoing cardiac surgery, perioperative statin treatment did not reduce the risk of AKI. Statin therapy should not be initiated to prevent AKI following cardiac surgery.