Ischaemic preconditioning for the reduction of renal ischaemia reperfusion injury

Abstract

Remote ischaemic preconditioning by cuff inflation appears to be a safe method, and probably leads to little or no difference in serum creatinine, adverse effects, need for dialysis, length of hospital stay, death and in the incidence of acute kidney injury. Overall we had moderate-high certainty evidence however the available data does not confirm the efficacy of remote ischaemic preconditioning in reducing renal ischaemia reperfusion injury in patients undergoing major cardiac and vascular surgery in which renal ischaemia reperfusion injury may occur.

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…In high‐risk patients undergoing cardiac surgery, the rate of AKI and the need for RRT have been found to be significantly decreased using RIPC, whereas in studies of unselected patients with nonstandardized intraoperative technique, no renal benefit was observed . Results of recent meta‐analyses have failed to demonstrate the efficacy of RIPC in reducing the incidence of AKI or the need for RRT . Importantly, these meta‐analyses included studies involving low‐risk patients and studies that used propofol.…”

“…25,26 Results of recent meta-analyses have failed to demonstrate the efficacy of RIPC in reducing the incidence of AKI or the need for RRT. [197][198][199][200] Importantly, these metaanalyses included studies involving low-risk patients and studies that used propofol. In a subgroup of studies in which propofol was not used, a reduction in AKI was demonstrated, suggesting a possible interaction of propofol with the protective effects of RIPC.…”

Donor cardiac arrest and cardiopulmonary resuscitation: impact on outcomes after simultaneous pancreas–kidney transplantation – a retrospective study

“…Even though CA and CPR have been regarded as injurious to donor organs [37][38][39][40], reports exist that show that ischemia and subsequent reperfusion may actually have a protective influence. Ischemic preconditioning, effectively an outcome of donor CA, has been repeatedly reported to improve outcomes after transplantation in other solid organ transplant as well as pancreas [41][42][43][44][45][46]. With an ischemic episode and subsequent restoration of blood flow, the preconditioning effect has the potential to decrease the ischemia-reperfusion injury seen with all organs subject to ischemia time in transplantation, though exact mechanisms have not been identified in this context [45].…”

Ischaemic Preconditioning: The Rationale and Evidence-Based Outcomes

“…This results in profound impairment of mitochondrial activity, ATP production and cell death. The end result of ischaemic preconditioning signalling is inhibition of this effect [3]. The protective effect of remote preconditioning implies that the molecules and mechanisms activated within the skeletal muscle of the preconditioned arm are transferred systemically to provide a similar protective effect across the body and its various organs.…”

“…As a result of activation of the humeral and neurogenic pathways, kinase cascades are induced which will mitigate open mitochondrial permeability transition pores; the immune pathway probably works by modulation of gene and receptor expression on immune cells modulating the inflammatory response. The second window of protection also implicates release of iNOS and COX-2 [3]. involve clamping of one of the iliac arteries once the peritoneal cavity is opened and before the reconstructive procedure for either aneurysmal or occlusive disease takes place.…”