High prevalence of undiagnosed kidney disease in those presenting with troponin positive acute coronary syndrome

Acute kidney injury in statin initiators

PURPOSE

Statins are widely used for preventing cardiovascular disease, yet recent reports suggest an increased risk of acute kidney injury (AKI). We estimated the one-year risk of AKI associated with statin initiation and determined the comparative safety of individual statin formulations.

METHODS

We performed a cohort study in insurance billing data from commercial and Medicare insurance plans in the United States for the years 2000-2010. We identified statin initiators and non-users with histories of medication use and healthcare utilization. AKI diagnosis codes were identified in the one year following the index date. We estimated hazard ratios (HR) and 95% confidence intervals (CI) with adjusted and propensity score (PS)-matched Cox-proportional hazards models. Models were run separately in insurance groups and adjusted for cardiovascular and renal risk factors, markers of healthcare utilization, and other medication use.

RESULTS

We identified 3,905,155 statin initiators and 2,817,621 eligible non-users. The adjusted HR of AKI in statin initiators compared to non-users was: commercial, HR = 1.04 (95% CI: 0.99, 1.09); Medicare, HR = 0.72 (95% CI: 0.70, 0.75). PS-matching yielded: commercial, HR = 0.82 (95% CI: 0.78, 0.87); Medicare, HR = 0.66 (95% CI: 0.63, 0.69). As individual formulations, higher-potency simvastatin was associated with an increased risk of AKI over lower-potency simvastatin in adjusted models: commercial, HR = 1.42 (95% CI: 1.28, 1.58); Medicare, HR = 1.24 (95% CI: 1.15, 1.35).

CONCLUSIONS

As a class, statin initiation was not associated with an increase in AKI. However, higher-potency simvastatin did exhibit an increased AKI risk.