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



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.


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.


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