Acute kidney injury in statin initiators

ABSTRACT 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....

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Published in:Pharmacoepidemiology and drug safety 2013-10, Vol.22 (10), p.1061-1070
Main Authors: Layton, J. Bradley, Brookhart, M. Alan, Jonsson Funk, Michele, Simpson Jr, Ross J., Pate, Virginia, Stürmer, Til, Kshirsagar, Abhijit V.
Format: Article
Language:English
Subjects:
acute kidney injury
Acute Kidney Injury - chemically induced
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Cohort Studies
comparative effectiveness
drug safety
Drug toxicity and drugs side effects treatment
Drug-Related Side Effects and Adverse Reactions
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects
Insurance Claim Review
Kidney diseases
Male
Medical sciences
Medicare - statistics & numerical data
Middle Aged
pharmacoepidemiology
Pharmacology
Pharmacology. Drug treatments
propensity scores
Risk factors
Simvastatin - adverse effects
Statins
Toxicity: urogenital system
United States
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Summary:ABSTRACT 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. Copyright © 2013 John Wiley & Sons, Ltd.
ISSN:1053-8569
1099-1557
DOI:10.1002/pds.3500