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    Critical Appraisal Treatment: Emmanuel D. Margate, JR

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    Emmanuel Margate
    - A 43-year-old man was admitted with chronic kidney disease stage 4 from tubulointerstitial nephropathy and was found to have increased creatinine and a reduced estimated GFR. - A randomized controlled trial evaluated the effectiveness of short-term high-dose atorvastatin therapy in preventing contrast-induced nephropathy in patients undergoing CT scans. - The study found that patients who received 80mg of atorvastatin prior to angiography had a significantly lower risk of developing contrast-induced nephropathy compared to the placebo group, with a number needed to treat of 13.69.

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    Critical Appraisal Treatment: Emmanuel D. Margate, JR

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    Emmanuel Margate
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    - A 43-year-old man was admitted with chronic kidney disease stage 4 from tubulointerstitial nephropathy and was found to have increased creatinine and a reduced estimated GFR. - A randomized controlled trial evaluated the effectiveness of short-term high-dose atorvastatin therapy in preventing contrast-induced nephropathy in patients undergoing CT scans. - The study found that patients who received 80mg of atorvastatin prior to angiography had a significantly lower risk of developing contrast-induced nephropathy compared to the placebo group, with a number needed to treat of 13.69.

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    Critical Appraisal

    Original Title

    ATORVASTATIN-CIN

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    - A 43-year-old man was admitted with chronic kidney disease stage 4 from tubulointerstitial nephropathy and was found to have increased creatinine and a reduced estimated GFR. - A randomized controlled trial evaluated the effectiveness of short-term high-dose atorvastatin therapy in preventing contrast-induced nephropathy in patients undergoing CT scans. - The study found that patients who received 80mg of atorvastatin prior to angiography had a significantly lower risk of developing contrast-induced nephropathy compared to the placebo group, with a number needed to treat of 13.69.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    28 views21 pages

    Critical Appraisal Treatment: Emmanuel D. Margate, JR

    Uploaded by

    Emmanuel Margate
    - A 43-year-old man was admitted with chronic kidney disease stage 4 from tubulointerstitial nephropathy and was found to have increased creatinine and a reduced estimated GFR. - A randomized controlled trial evaluated the effectiveness of short-term high-dose atorvastatin therapy in preventing contrast-induced nephropathy in patients undergoing CT scans. - The study found that patients who received 80mg of atorvastatin prior to angiography had a significantly lower risk of developing contrast-induced nephropathy compared to the placebo group, with a number needed to treat of 13.69.

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    Critical Appraisal

    Treatment

    Emmanuel D. Margate, Jr.


    CASE SCENARIO
    • 43/M
    • Consult done with gastroenterologist due to abdominal pain
    • Triple Contrast Enhanced CT was requested
    • Found out to have increased creatinine at 3.36mg/dL with eGFR of
    21ml/min
    • Referred to a nephrologist and was then admitted as a Case of CKD 4
    from Tubulointerstitial Nephropathy
    Directness
    •P : Patients undergoing Contrast Enhanced CT Scan
    •I : Short Term High Dose Atorvastatin Therapy
    •O : Prevention of Contrast-Induced Nephropathy
    •M : Randomized controlled trial

    Clinical Question:
    Is short term high dose treatment of atorvastatin effective in the
    prevention of contrast-induced nephropathy in patients
    undergoing computed tomography with contrast in a randomized
    controlled trial?
    Relevance: Is the objective of the article
    comparing therapeutic interventions similar to your
    clinical dilemma?

    STUDY CLINICAL QUESTION

    Population Patients undergoing Angiography Patients undergoing Contrast Enhanced


    CT
    Intervention Atorvastatin 80mg Atorvastatin 80mg

    Outcome Prevention of Contrast-Induced Prevention of Contrast-Induced


    Nephropathy Nephropathy
    Relevance: Is the objective of the article
    comparing therapeutic interventions similar to your
    clinical dilemma

    • Objective of the article: To evaluate the


    effectiveness of 80mg atorvastatin in the
    prevention of contrast-induced nephropathy
    in patients undergoing Angiography
    • Clinical Question: Is short term high dose
    treatment of atorvastatin effective in the
    prevention of contrast-induced nephropathy
    in patients undergoing computed tomography
    with contrast?
    Validity: Was the assignment of patients to
    treatment randomized?
    Validity: Was the Allocation concealed?
    • No discussion about allocation concealment
    Validity : Were patients, their clinicians,
    and study personnel ”blind” to treatment?
    Validity : Were the groups similar at the
    start of the trial?
    Validity : Were the patients analyzed in the groups to
    which they were randomized? (intent–to-treat analysis)
    Validity: Aside from the experimental
    intervention, were the groups treated equally?
    • No co-interventions mentioned
    OVERALL, IS THE STUDY VALID?
    • All validity guidelines were met
    • Absolute Risk in Control (Rc) = 11/110 = 0.1
    • Absolute Risk in Tx (Rt) = 3/110 = 0.027
    • Absolute Risk Reduction (Rc-Rt) = 0.073
    • Relative Risk (Rt/Rc) = 0.27
    • Relative Risk Reduction (Rc-Rt/Rc) = 0.73
    • NNT (1/ARR) = 13.69
    WHAT ARE THE RESULTS?

    • Decision (a= 0.05)


    • Atorvastatin 80mg vs Placebo
    • P value – 0.01
    • p < a, indicates strong evidence against the null hypothesis, so null
    hypothesis can be rejected. Therefore, a high dose of Atorvastatin
    significantly reduces risk of CIN 24 hours after contrast medium
    injection.
    Can the results be applied to my patient?
    INCLUSION CRITERIA (At LEAST 1) EXCLUSION CRITERIA
    • Diabetes (fasting blood sugar > 126 mg/dL, random • Recent treatment with 80 mg of statin (not low-
    blood sugar > 200 mg/dL, and glucose tolerance dose atorvastatin) need for emergency angiography
    test 200 mg/dL) • Contraindications to statin prescription
    • Chronic renal failure (creatinine > 1.5 mg/dL or 15 < • Previous contrast-media administration during the
    glomerular filtration rate [GFR] < 60 preceding 10 days
    mls/min/1.73m2) • Chronic dialysis treatment
    • Informed refusal of consent
    Were all clinically important outcomes
    considered?
    RESOLUTION OF THE PROBLEM IN
    THE SCENARIO

    • Standard hydration and N-acetylcysteine and atorvastatin (80 mg)


    reduced the incidence of CIN, and this regimen was more effective
    than was the regimen of hydration and N-acetylcysteine (without
    atorvastatin) in decreasing CIN. Accordingly, it is reasonable to
    prescribe atorvastatin before angiography in high-risk patients.
    Thank you!

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