High-Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery

Loren E Smith; Derek K Smith; Jeffrey D Blume; MacRae F Linton; Frederic T Billings IV

doi:10.1161/JAHA.117.006975

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High-Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery

Journal article

Open access

Peer reviewed

High-Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery

Loren E Smith, Derek K Smith, Jeffrey D Blume, MacRae F Linton and Frederic T Billings IV

Journal of the American Heart Association, Vol.6(12), p.n/a

12/2017

DOI: 10.1161/JAHA.117.006975

PMCID: PMC5779016

PMID: 29223955

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https://doi.org/10.1161/JAHA.117.006975View

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Abstract

Acute kidney injury (AKI) after cardiac surgery is associated with increased short- and long-term mortality. Inflammation, oxidative stress, and endothelial dysfunction and damage play important roles in the development of AKI. High-density lipoproteins (HDLs) have anti-inflammatory and antioxidant properties and improve endothelial function and repair. Statins enhance HDL's anti-inflammatory and antioxidant capacities. We hypothesized that a higher preoperative HDL cholesterol concentration is associated with decreased AKI after cardiac surgery and that perioperative statin exposure potentiates this association. We tested our hypothesis in 391 subjects from a randomized clinical trial of perioperative atorvastatin to reduce AKI after cardiac surgery. A 2-component latent variable mixture model was used to assess the association between preoperative HDL cholesterol concentration and postoperative change in serum creatinine, adjusted for known AKI risk factors and suspected confounders. Interaction terms were used to examine the effects of preoperative statin use, preoperative statin dose, and perioperative atorvastatin treatment on the association between preoperative HDL and AKI. A higher preoperative HDL cholesterol concentration was independently associated with a decreased postoperative serum creatinine change ( =0.02). The association between a high HDL concentration and an attenuated increase in serum creatinine was strongest in long-term statin-using patients ( =0.008) and was further enhanced with perioperative atorvastatin treatment ( =0.004) and increasing long-term statin dose ( =0.003). A higher preoperative HDL cholesterol concentration was associated with decreased AKI after cardiac surgery. Preoperative and perioperative statin treatment enhanced this association, demonstrating that pharmacological potentiation is possible during the perioperative period. URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00791648.

Acute Kidney Injury - blood

Acute Kidney Injury - etiology

Acute Kidney Injury - prevention & control

Aged

Aged, 80 and over

Atorvastatin - administration & dosage

Cardiac Surgical Procedures - adverse effects

Cholesterol, HDL - blood

Coronary Artery Disease - blood

Coronary Artery Disease - surgery

Dose-Response Relationship, Drug

Double-Blind Method

Female

Follow-Up Studies

Humans

Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage

Kidney Function Tests

Male

Middle Aged

Postoperative Complications

Postoperative Period

Preoperative Period

Risk Factors

Treatment Outcome

Details

Title: Subtitle: High-Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery
Creators: Loren E Smith - Vanderbilt University Medical Center
Derek K Smith - Vanderbilt University Medical Center
Jeffrey D Blume - Vanderbilt University Medical Center
MacRae F Linton - Vanderbilt University Medical Center
Frederic T Billings IV - Vanderbilt University Medical Center
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.6(12), p.n/a
DOI: 10.1161/JAHA.117.006975
PMID: 29223955
PMCID: PMC5779016
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Grant note: UL1 TR002243 / NCATS NIH HHS T32 GM108554 / NIGMS NIH HHS R01 GM112871 / NIGMS NIH HHS UL1 TR000445 / NCATS NIH HHS K23 GM102676 / NIGMS NIH HHS P01 HL116263 / NHLBI NIH HHS
Language: English
Date published: 12/2017
Academic Unit: Preventive and Community Dentistry; Anesthesia; Dental Research
Record Identifier: 9984949264202771

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