Key result
Carvedilol plus moderate-dose atorvastatin shows no benefit over high-dose atorvastatin for contrast-induced nephropathy.
Why the study?
Contrast-induced nephropathy increases morbidity and short-term hemodialysis risk, but the optimal preventive approach remains controversial.
Does a combined carvedilol and moderate dose atorvastatin regimen prevent contrast-induced nephropathy better than high dose atorvastatin in patients undergoing elective cardiac catheterization?
RCT (n=144)
Randomized
Does a combined carvedilol and moderate dose atorvastatin regimen prevent contrast-induced nephropathy better than high dose atorvastatin in patients undergoing elective cardiac catheterization?
Absolute Event Rate: 12.2% vs 8.2%
p-value: p=0.420
Combined carvedilol and moderate-dose statin is comparable to high-dose atorvastatin for preventing contrast-induced nephropathy, though high-dose atorvastatin may better preserve kidney function markers.
No CIN benefit from adding carvedilol to moderate-dose atorvastatin; leaves open whether high-dose statin confers superior renal protection.
Background: Contrast-induced nephropathy (CIN) is associated with increased morbidity, and the need for short-term hemodialysis. Although several preventive measures have been used, the best approach to prevent CIN is still controversial. Objectives: This study is intended to evaluate the protective effect of carvedilol/ medium dose statin compared to the recommended high dose atorvastatin on the development CIN in patients undergoing elective cardiac catheterization (CC). Methods: A total of 144 patients planned for CC were randomly assigned to: • Group (A): 49 patients received atorvastatin as single high dose 80 mg 12 hours before CC and another 40 mg of atorvastatin 2 hours before PCI. • Group (B): 48 patients were prescribed carvedilol 12.5 mg twice daily for seven days before CC and continued for 24 hours post CC, plus 40 mg atorvastatin 12 hours before CC. • Group (C): 47 patients received 40 mg atorvastatin 12 hours before CC. Results: The baseline characteristics of the 3 groups were comparable. CIN incidence was the lowest in group A, but was not significantly different (p=0.420). CIN developed in 4 (8.2%), 6(12.2%), and 8(17%) patients in groups A, B, and C respectively. Median change in CrCl 48 hours, and serum NGAL 4 hours post CC was significantly lower in group A compared to group C (p=0.0330, p=0.0348 respectively). Conclusions: The present study revealed that, combined carvedilol/statin regimen was comparable to single high dose atorvastatin in CIN prevention. However, short high dose of atorvastatin might be preferable in terms of kidney function preservation.
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EL-Gazara et al. (2021) conducted an RCT in Contrast-induced nephropathy after elective cardiac catheterization (n=144). Combined carvedilol and moderate dose atorvastatin vs. High dose atorvastatin (80 mg 12h before CC + 40 mg 2h before PCI) or moderate dose atorvastatin (40 mg 12h before CC) was evaluated on Incidence of contrast-induced nephropathy (CIN) (p=0.420). Combined carvedilol and moderate-dose atorvastatin resulted in a 12.2% incidence of contrast-induced nephropathy compared to 8.2% with high-dose atorvastatin (p=0.420).
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