Introduction: Contrast-induced nephropathy (CIN) is a major cause of mortality and morbidity including increased incidence of hemodialysis, length of hospitalization and healthcare costs. Studies have shown that statins can reduce CIN. However, when compared with conventional therapies [(normal saline (NS), sodium bicarbonate (SB) and N-acetyl Cysteine (NAC)], the effects of statins are not clearly delineated. Consequently, we performed a Bayesian analysis to generate indirect evidence for investigating this issue.
Hypothesis: When compared with conventional therapies, statins can serve as better or at least comparable agents in preventing CIN.
Methods: 49 Randomized trials (RCTs) were extracted using MEDLINE, EMBASE and Cochrane Library (inception- April 2017). Estimates are reported as random effects [odds ratio with (95% credible intervals)]. Treatments were ranked based on Surface Under the Cumulative Ranking Curve (SUCRA).
Results: In analysis of 18,353 patients [NS (n=8052), SB (n=2729), NAC (n=4265), Statin (2543) and Placebo (n=764)]; statin significantly reduced the risk of CIN compared to NS [0.46 (0.24-0.84)] while other arms failed to highlight significant differences (Figure). Probability analysis ranked statins as the most effective drug (SUCRA, 97%) followed by NAC (SUCRA, 69%) and SB (SUCRA, 51%). There were no significant differences between interventions with regards to need for hemodialysis. However, statins were consistently ranked superior (SUCRA, 88%) to other treatments.
Conclusions: Statins reduced the risk of CIN in patients undergoing cardiac catheterization. Probability analysis ranked statins as the most effective treatment for prevention of CIN and need for hemodialysis.