The effects of atorvastatin on contrast-induced acute kidney injury; a systematic review and meta-analysis on clinical trials

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a major acute renal failure that can be prevented by atorvastatin administration. This study aims to evaluate the association between atorvastatin use and CI-AKI incidence using a systematic review and meta-analysis approach. Materials and Methods: Several international databases, including Cochrane, Web of Science, Scopus, ProQuest, PubMed, and the Google Scholar search engine, were queried in this study. STATA 14 software was conducted to analyze the data. In this study, standardized mean difference (SMD) index was conducted to investigate the relationship between atorvastatin and serum creatinine level. Results: Twelve clinical trials with a total sample size of 3299 were retrieved. The effect of atorvastatin on serum creatinine levels indicated a SMD of -2.26 (95% CI: -2.53, -1.98) at a dose of 20 mg/kg, -0.76 (95% CI: -1.47, -0.05) at a dose of 40 mg/kg, -2.69 (95% CI: -2.96, -2.42) at a dose of 60 mg/ kg, and -0.03 (95% CI: -0.14, 0.09) at a dose of 80 mg/kg. The effect of atorvastatin use on serum creatinine levels achieved a SMD of -2.72 (95% CI: -3.02, -2.43) in the 40-49 years age group and a SMD of -0.96 (95% CI: -1.73, -0.19) in the 50-59 years age group. The effect of high-dose atorvastatin therapy in reducing the serum creatinine levels, compared to low-dose therapy, was a SMD of -0.54 (95% CI: -1.03, -0.04). However, estimates for the effect of atorvastatin compared to rosuvastatin and placebo showed a SMD of -0.26 (95% CI: -0.76, 0.24) and -1.23 (95% CI: -2.22, -0.25), respectively. The effect of atorvastatin on blood urea nitrogen (BUN) and high-sensitivity C-reactive protein (hs-CRP) levels relative to the comparison group was a SMD of -1.10 (95% CI: -1.61, -0.58) and -1.36 (95% CI: -2.30, -0.42) respectively. Conclusion: Pre-treatment with atorvastatin is effective in CI-AKI prevention. High-dose atorvastatin administration at younger ages provides the best outcome for preventing CI-AKI. Meta-analysis Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID: CRD42023397276, available at https:// www.crd.york.ac.uk/prospero/#recordDetails).