A Randomized Controlled Study of Remote Ischemic Preconditioning for Prevention of Contrast-Induced Nephropathy



Krishnaswamy Sampathkumar1, *, Ratchagan Saravanan1
1 Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, India

Abstract

Introduction:

Remote Ischemic Preconditioning (RIPC) is a technique which applies brief periods of reversible ischemia and reperfusion to limbs provoking adaptive protective responses to distant organs like Heart, Kidneys and Brain.

Methods:

Its efficacy in the prevention of Contrast Nephropathy was tested in our open-label, randomized and sham- controlled study. 100 patients with Chronic Kidney Disease Stages 1-3a requiring Contrast agent for Percutaneous Coronary Interventions were included. Subjects were randomized in a 1:1 ratio to receive either Remote Ischemic Preconditioning (RIPC) or sham preconditioning.

Results & Discussion:

Both groups were treated with Intravenous saline therapy before contrast exposure. The primary end point was contrast-Induced AKI. Baseline characteristics were comparable in both groups. Mean GFR in ml/min was similar in both groups (RIPC 54.8+/- 9 ml/min; Control 54.8+/- 9 ml/min) . Contrast-induced AKI occurred in 19/50 patients in control group and 6/50 in IPC group (p = 0.005).Hemodialysis was required only in control group (4/50) (p = 0.058). 30 day rehospitalization was more in control group (8 / 50) than RIPC group (1/50) (p = 0.01). RIPC was well- tolerated without adverse effects.

Conclusion:

In conclusion, remote ischemic preconditioning applied before contrast exposure prevents contrast-induced acute kidney injury in CKD 3a. This simple procedure can be added to intravenous saline therapy for nephroprotection.

Keywords: AKI, Coronary angiogram, Contrast nephropathy, Remote ischemic preconditioning, Heart, Kidney, Brain.


Abstract Information


Identifiers and Pagination:

Year: 2019
Volume: 12
Publisher Item Identifier: EA-TOUNJ-2019-1

Article History:

Received Date: 12/07/2019
Revision Received Date: 21/09/2019
Acceptance Date: 24/09/2019
Electronic publication date: 25/10/2019
Collection year: 2019

© 2019 Sampathkumar et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, India; Tel: +9994872250; E-mail: drksampath@gmail.com