Statin use and in-hospital outcomes among chronic kidney disease patients: a retrospective cohort study

Abstract Background Chronic kidney disease (CKD) represents a significant burden of cardiovascular disease and acute kidney injury (AKI). Statins were recommended in CKD for cardiovascular benefits, while their effect on AKI remains inconsistent. Methods All adult hospital admissions between January 1, 2018, and December 31, 2020 were retrospectively screened, and CKD patients were included. Exposure was defined as any statin prescription within 48 hours of admission. Patients were followed up until death or discharge or a maximum period of up to 30 days. The primary outcome was in-hospital AKI, and the secondary outcome was in-hospital mortality. Results Among 5,376 patients enrolled, the median age was 72 years, 3,184 (59.2%) were male, and 2,129 (39.6%) were statin users. In-hospital AKI occurred in 149(7.0%) of statin users and 213(6.6%) of non-users. Statin use was associated with a significantly decreased risk of in-hospital AKI (adjusted hazard ratio [aHR], 0.74; 95% confidence interval [CI] 0.57–0.96), and in-hospital mortality (aHR 0.44; 95% CI 0.23–0.82). A significantly decreased risk of in-hospital AKI was observed in both atorvastatin users and rosuvastatin users. These findings remained consistent in subgroup analyses stratified by age, gender, baseline eGFR, and cardiovascular disease (All P for interaction > 0.05). Conclusions Statins may not only improve survival but also protect against AKI in CKD patients.