Blog entry by Meguid El Nahas
Molnar and colleagues in the May issue of JASN report a population based retrospective cohort study of 213,347 older patients who underwent elective surgery in Canada. They noted that statin use was associated with a 16% reduction in the risk of postoperative AKI. This adds support to previous experimental and smaller clinical observations suggestive of such protective effect as well as protection against preoperative cardiac events and even mortality. Statin are pleotropic agents that potentially exert a number of renoprotective actions including mitigating the renal ischema/reperfusion injury induced inflammatory response associated with AKI. One limitation of this study is the retrospective nature of the observation but the authors took great car to adjust for a large number of patients and healthcare confounders by multivariate analysis as well as propensity-based matching of patients on and off statin therapy. Until such observation is confirmed by a prospective RCT, it may be advisable to consider statin therapy to minimise AKI in elderly patients undergoing major surgical procedures.