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Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases.
BMJ. 2013 Mar 18; 346:f880.BMJ

Abstract

OBJECTIVE

To quantify an association between acute kidney injury and use of high potency statins versus low potency statins.

DESIGN

Retrospective observational analysis of administrative databases, using nine population based cohort studies and meta-analysis. We performed as treated analyses in each database with a nested case-control design. Rate ratios for different durations of current and past statin exposure to high potency or low potency statins were estimated using conditional logistic regression. Ratios were adjusted for confounding by high dimensional propensity scores. Meta-analytic methods estimated overall effects across participating sites.

SETTING

Seven Canadian provinces and two databases in the United Kingdom and the United States.

PARTICIPANTS

2,067,639 patients aged 40 years or older and newly treated with statins between 1 January 1997 and 30 April 2008. Each person hospitalized for acute kidney injury was matched with ten controls.

INTERVENTION

A dispensing event was new if no cholesterol lowering drug or niacin prescription was dispensed in the previous year. High potency statin treatment was defined as ≥ 10 mg rosuvastatin, ≥ 20 mg atorvastatin, and ≥ 40 mg simvastatin; all other statin treatments were defined as low potency. Statin potency groups were further divided into cohorts with or without chronic kidney disease.

MAIN OUTCOME MEASURE

Relative hospitalization rates for acute kidney injury.

RESULTS

Of more than two million statin users (2,008,003 with non-chronic kidney disease; 59,636 with chronic kidney disease), patients with similar propensity scores were comparable on measured characteristics. Within 120 days of current treatment, there were 4691 hospitalizations for acute kidney injury in patients with non-chronic kidney injury, and 1896 hospitalizations in those with chronic kidney injury. In patients with non-chronic kidney disease, current users of high potency statins were 34% more likely to be hospitalized with acute kidney injury within 120 days after starting treatment (fixed effect rate ratio 1.34, 95% confidence interval 1.25 to 1.43). Users of high potency statins with chronic kidney disease did not have as large an increase in admission rate (1.10, 0.99 to 1.23). χ(2) tests for heterogeneity confirmed that the observed association was robust across participating sites.

CONCLUSIONS

Use of high potency statins is associated with an increased rate of diagnosis for acute kidney injury in hospital admissions compared with low potency statins. The effect seems to be strongest in the first 120 days after initiation of statin treatment.

Authors+Show Affiliations

Department of Anesthesiology, University of British Columbia, Vancouver, Victoria, BC, Canada V8W 1Y2. colin.dormuth@ti.ubc.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23511950

Citation

Dormuth, Colin R., et al. "Use of High Potency Statins and Rates of Admission for Acute Kidney Injury: Multicenter, Retrospective Observational Analysis of Administrative Databases." BMJ (Clinical Research Ed.), vol. 346, 2013, pp. f880.
Dormuth CR, Hemmelgarn BR, Paterson JM, et al. Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases. BMJ. 2013;346:f880.
Dormuth, C. R., Hemmelgarn, B. R., Paterson, J. M., James, M. T., Teare, G. F., Raymond, C. B., Lafrance, J. P., Levy, A., Garg, A. X., & Ernst, P. (2013). Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases. BMJ (Clinical Research Ed.), 346, f880. https://doi.org/10.1136/bmj.f880
Dormuth CR, et al. Use of High Potency Statins and Rates of Admission for Acute Kidney Injury: Multicenter, Retrospective Observational Analysis of Administrative Databases. BMJ. 2013 Mar 18;346:f880. PubMed PMID: 23511950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases. AU - Dormuth,Colin R, AU - Hemmelgarn,Brenda R, AU - Paterson,J Michael, AU - James,Matthew T, AU - Teare,Gary F, AU - Raymond,Colette B, AU - Lafrance,Jean-Philippe, AU - Levy,Adrian, AU - Garg,Amit X, AU - Ernst,Pierre, AU - ,, Y1 - 2013/03/18/ PY - 2013/3/21/entrez PY - 2013/3/21/pubmed PY - 2013/5/7/medline SP - f880 EP - f880 JF - BMJ (Clinical research ed.) JO - BMJ VL - 346 N2 - OBJECTIVE: To quantify an association between acute kidney injury and use of high potency statins versus low potency statins. DESIGN: Retrospective observational analysis of administrative databases, using nine population based cohort studies and meta-analysis. We performed as treated analyses in each database with a nested case-control design. Rate ratios for different durations of current and past statin exposure to high potency or low potency statins were estimated using conditional logistic regression. Ratios were adjusted for confounding by high dimensional propensity scores. Meta-analytic methods estimated overall effects across participating sites. SETTING: Seven Canadian provinces and two databases in the United Kingdom and the United States. PARTICIPANTS: 2,067,639 patients aged 40 years or older and newly treated with statins between 1 January 1997 and 30 April 2008. Each person hospitalized for acute kidney injury was matched with ten controls. INTERVENTION: A dispensing event was new if no cholesterol lowering drug or niacin prescription was dispensed in the previous year. High potency statin treatment was defined as ≥ 10 mg rosuvastatin, ≥ 20 mg atorvastatin, and ≥ 40 mg simvastatin; all other statin treatments were defined as low potency. Statin potency groups were further divided into cohorts with or without chronic kidney disease. MAIN OUTCOME MEASURE: Relative hospitalization rates for acute kidney injury. RESULTS: Of more than two million statin users (2,008,003 with non-chronic kidney disease; 59,636 with chronic kidney disease), patients with similar propensity scores were comparable on measured characteristics. Within 120 days of current treatment, there were 4691 hospitalizations for acute kidney injury in patients with non-chronic kidney injury, and 1896 hospitalizations in those with chronic kidney injury. In patients with non-chronic kidney disease, current users of high potency statins were 34% more likely to be hospitalized with acute kidney injury within 120 days after starting treatment (fixed effect rate ratio 1.34, 95% confidence interval 1.25 to 1.43). Users of high potency statins with chronic kidney disease did not have as large an increase in admission rate (1.10, 0.99 to 1.23). χ(2) tests for heterogeneity confirmed that the observed association was robust across participating sites. CONCLUSIONS: Use of high potency statins is associated with an increased rate of diagnosis for acute kidney injury in hospital admissions compared with low potency statins. The effect seems to be strongest in the first 120 days after initiation of statin treatment. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/23511950/Use_of_high_potency_statins_and_rates_of_admission_for_acute_kidney_injury:_multicenter_retrospective_observational_analysis_of_administrative_databases_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=23511950 DB - PRIME DP - Unbound Medicine ER -