Remote ischemic preconditioning for prevention of contrast induced nephropathy—Insights from an Indian study

Abstract

ObjectivesTo study if four cycles of remote ischemic preconditioning (RIPC) could offer protection against contrast induced nephropathy (CIN) and post procedural renal dysfunction in high risk patients undergoing percutaneous coronary intervention (PCI).MethodsThis was a prospective single blind randomized sham controlled trial where patients undergoing coronary angioplasty with stage III chronic kidney disease were randomized into sham preconditioning and remote ischemic preconditioning. The primary outcome was the reduction in the incidence of CIN. The secondary outcomes were the maximum improvement in eGFR, maximum reduction in serum creatinine and composite of requirement of hemodialysis, death and rehospitalization for heart failure up to 6 weeks after PCI.ResultsEleven out of fifty patients in the study group developed CIN (22%) compared to eighteen out of the fifty control patients (36%) (p = 0.123). There was a statistically significant improvement in the post procedure creatinine values at 24 h (p = 0.013), 48 h (p = 0.015), 2 weeks (p = 0.003), 6 weeks (p = 0.003) and post procedure glomerular filtration rate (eGFR) values at 24 h (p = 0.026), 48 h (p = 0.044), 2 weeks (p = 0.015) and 6 weeks (p = 0.011) in study group compared to control group. The secondary outcome composite of requirement of hemodialysis, death and rehospitalization for heart failure was not statistically significant (p: 0.646).ConclusionRIPC does not result in significant reduction of CIN. However RIPC helps in the prevention of post procedural worsening in eGFR and serum creatinine even up to 6 weeks.

Remote Ischemic Preconditioning Reduces the Risk of Contrast-Induced Nephropathy in Patients with Moderate Renal Impairment Undergoing Percutaneous Coronary Angiography: A Meta-Analysis

“…However, Hu et al [51] included 10 RCTs with 1,167 patients, and Bei et al [50] included 7 RCTs with 957 patients, whereas the present study included 16 RCTs with 2,048 patients. Inconsistent with the results of these 2 meta-analyses, 3 recent trials reported that RIPC did not significantly reduce CIN [29, 30, 35]. Here, we included 6 updated additional RCTs to assess the effect of RIPC for CIN in a more comprehensive manner.…”

“…In the study by Er et al [18], the level of serum creatinine was significantly higher after 48 h in control patients compared to patients with RIPC. Valappil et al [29] showed that there was a statistically significant reduction in the serum creatinine at 24 h, 48 h, 2 weeks, and 6 weeks in the RIPC group compared to the sham group. However, Ghaemian et al [22] found that there was no statistically significant difference between the RIPC and control groups in serum creatinine levels 48–72 h after the procedure.…”

“…Two studies reported no statistically significant difference between the RIPC and control groups in eGFR after the procedure [24, 35]. In contrast, Valappil et al [29] found significant improvement in eGFR after the procedure in the RIPC group compared to the sham one at 24 h, 48 h, 2 weeks, and 6 weeks. Moreover, one study compared the maximum decrease in eGFR between the RIPC group and the control group [32].…”

Effects of Remote Ischemic Pre-Conditioning to Prevent Contrast-Induced Nephropathy after Intravenous Contrast Medium Injection: A Randomized Controlled Trial

“…In patients with a moderate-to-high risk of CIN, who underwent IA CM injection for CA or percutaneous coronary angioplasty, the effects of RIPC are controversial, with several controlled studies demonstrating that RIPC reduces the incidence of CIN ( 14 15 16 17 24 ), while others reported no difference in the incidence of CIN ( 19 21 22 ). However, several meta-analyses have concluded that RIPC is effective in reducing the risk of CIN ( 26 27 28 ).…”

“…The principal evaluation criterion was the incidence of CIN, defined as an increase in the serum creatinine levels higher than or equal to the value of 0.5 mg/dL or a relative increase of 25%, 48 hours after the CM injection, as stated in similar previous publications ( 14 15 21 22 23 24 ).…”