Remote ischemic preconditioning reduces the incidence of contrast‐induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta‐analysis of randomized controlled trials

Pranata, Raymond; Tondas, Alexander Edo; Vania, Rachel; Toruan, Mangiring P.L.; Lukito, Antonia Anna; Siswanto, Bambang Budi

doi:10.1002/ccd.28709

Cited by 10 publications

(8 citation statements)

References 38 publications

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“…Our study has found that RIC was not only effective in reducing the incidence of CA-AKI in AMI, but also associated with an improved long-term prognosis. The current meta-analysis has extended previous finding that that RIC was effective in reducing CA-AKI in elective PCI [37,38]. In addition, our meta-analysis has indicated that RIC also showed a long-term cardiac protection in reducing MACE.…”

Section: Discussionsupporting

confidence: 76%

Hypertensive status is associated with renoprotection by remote ischemic conditioning for acute myocardial infarction—a meta-regression and trial sequential analysis of randomized clinical trials

Li¹,

Ying²,

Zhou³

et al. 2022

Rev. Cardiovasc. Med.

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The potential modifiable factors for remote ischemic conditioning (RIC) in reducing contrast-associated acute kidney injury (CA-AKI) in patients with acute myocardial infarction (AMI) have not been investigated. The aim of this meta-regression was to address these issues.We searched Pubmed, Embase and the Cochrane Library database for published randomized controlled trials (RCTs) with registration number CRD42020155532. Nine RCTs comprising of 1540 subjects were included in our meta-analysis. Compared with control group, RIC was associated with reduced incidence of CA-AKI [(9 studies, 1540 subjects, relative risk (RR) 0.51, 95% confidence intervals (CI) 0.35 to 0.76, p = 0.000, I 2 = 52%, p for heterogeneity 0.04)] and major adverse cardiovascular events (MACE) (5 studies, 1078 subjects, RR 0.52, 95% CI 0.38 to 0.73, p = 0.000, I 2 = 9%, p for heterogeneity 0.36) for AMI. In addition, both meta-regression and subgroup analyses have shown that RIC was more effective in the hypertensive patients in reducing CA-AKI for AMI (regression coefficient = -0.05, p = 0.021; for subgroup with more hypertensive patients: RR 0.36, 95% CI 0.25 to 0.52 vs the one with less hypertensive patients: RR 0.72, 95% CI (0.40 to 1.30, p for subgroup difference 0.008). Subsequent trial sequential analysis confirmed the effect of RIC in both CA-AKI and MACE. RIC is an effective strategy in reducing CA-AKI and MACE in patients with AMI, especially for patients with hypertension.

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Section: Discussionsupporting

confidence: 76%

Hypertensive status is associated with renoprotection by remote ischemic conditioning for acute myocardial infarction—a meta-regression and trial sequential analysis of randomized clinical trials

Li¹,

Ying²,

Zhou³

et al. 2022

Rev. Cardiovasc. Med.

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“…In addition, RIC may also activate antiapoptotic (40), antioedema (41), and anti-inflammatory signalling pathways (42), improve microvascular endothelial function (43), and affect the transcription of related genes and mitochondrial respiratory function (44,45), thereby reducing the impact of I/R injury. Clinical trials on RIC renal protection have been conducted in a variety of surgical types, including cardiac surgery, macrovascular surgery, and percutaneous coronary intervention, and this approach has gradually become a promising renal protection strategy and has been demonstrated in experimental and clinical studies (46)(47)(48). At present, a large number of meta-analyses have shown the protective effect of RIC on the kidney, such as renal protection after coronary angiography or interventional patients with contrast agents (46).…”

Section: Discussionmentioning

confidence: 99%

Protective role of remote ischemic conditioning in renal transplantation and partial nephrectomy: A systematic review and meta-analysis of randomized controlled trials

Zhang

Zeng

et al. 2023

Front. Surg.

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ObjectiveStudies have shown that remote ischemic conditioning (RIC) can effectively attenuate ischemic-reperfusion injury in the heart and brain, but the effect on ischemic-reperfusion injury in patients with kidney transplantation or partial nephrectomy remains controversial. The main objective of this systematic review and meta-analysis was to investigate whether RIC provides renal protection after renal ischemia-reperfusion injury in patients undergoing kidney transplantation or partial nephrectomy.MethodsA computer-based search was conducted to retrieve relevant publications from the PubMed database, Embase database, Cochrane Library and Web of Science database. We then conducted a systematic review and meta-analysis of randomized controlled trials that met our study inclusion criteria.ResultsEleven eligible studies included a total of 1,145 patients with kidney transplantation or partial nephrectomy for systematic review and meta-analysis, among whom 576 patients were randomly assigned to the RIC group and the remaining 569 to the control group. The 3-month estimated glomerular filtration rate (eGFR) was improved in the RIC group, which was statistically significant between the two groups on kidney transplantation [P < 0.001; mean difference (MD) = 2.74, confidence interval (CI): 1.41 to 4.06; I2 = 14%], and the 1- and 2-day postoperative Scr levels in the RIC group decreased, which was statistically significant between the two groups on kidney transplantation (1-day postoperative: P < 0.001; MD = 0.10, CI: 0.05 to 0.15, I2 = 0; 2-day postoperative: P = 0.006; MD = 0.41, CI: 0.12 to 0.70, I2 = 0), but at other times, there was no significant difference between the two groups in Scr levels. The incidence of delayed graft function (DGF) decreased, but there was no significant difference (P = 0.60; 95% CI: 0.67 to 1.26). There was no significant difference between the two groups in terms of cross-clamp time, cold ischemia time, warm ischemic time, acute rejection (AR), graft loss or length of hospital stay.ConclusionOur meta-analysis showed that the effect of remote ischemia conditioning on reducing serum creatinine (Scr) and improving estimate glomerular filtration rate (eGFR) seemed to be very weak, and we did not observe a significant protective effect of RIC on renal ischemic-reperfusion. Due to small sample sizes, more studies using stricter inclusion criteria are needed to elucidate the nephroprotective effect of RIC in renal surgery in the future.

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“…Significant improvement in medullary and cortex oxygenation following the RIPC procedure has been shown in humans [ 35 ]. Previous large randomised trials of the effect of RIPC on renal biomarkers and kidney function have led to promising results [ 36 ]. However, often conflicting results have been found due to heterogeneity of study designs and populations.…”

Section: Discussionmentioning

confidence: 99%

The Role of RIPC in Preventing Organ Damage, Inflammation, and Oxidative Stress during Lower Limb DSA: A Randomised Controlled Trial

Kuusik

Kasepalu

Zilmer

et al. 2021

Oxidative Medicine and Cellular Longevity

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Objective. Diagnostic digital subtraction angiography (DSA) and DSA with percutaneous transluminal angioplasty (DSA-PTA) are common procedures for diagnosing and treating symptomatic lower extremity arterial disease (LEAD). However, organ damage following DSA and DSA-PTA is often underrecognised and hence undiagnosed. To reduce the risk induced by invasive procedures in symptomatic LEAD patients, the method of remote ischemic preconditioning (RIPC) has been suggested. The aim of the current study was to assess the effect of RIPC intervention on the organ damage markers profile, oxidative stress, and inflammation biomarkers in LEAD patients undergoing DSA and DSA-PTA procedure. Methods. The RIPC intervention was performed by inflating a standard blood pressure cuff on the patient’s upper arm to 200 mmHg for 5 minutes four times with 5-minute perfusion between each cycle. The sham intervention was performed similarly, but the cuff was inflated to 20 mmHg. Changes in the cardiac and renal damage biomarkers’ profile, oxidative stress, and inflammation biomarkers were recorded before and 24 hours after DSA or DSA-PTA. Results. A total of 111 (RIPC 54, sham 57) patients with symptomatic LEAD scheduled for endovascular procedure were randomised, and 102 patients (RIPC 47, sham 55) completed the study protocol. RIPC significantly limited the increase of adiponectine levels after DSA and DSA-PTA, compared to sham intervention ( p = 0.020 ), but CK-MB levels were markedly lower in the sham group ( p = 0.047 ) after procedure. There was no significant difference between the RIPC and the sham group in mean changes in hs-troponin-T ( p = 0.25 ), NT-proBNP ( p = 0.24 ), creatinine ( p = 0.76 ), eGFR ( p = 0.61 ), urea ( p = 0.95 ), beta-2-microglobuline ( p = 0.34 ), or cystatine C ( p = 0.24 ) levels. Conclusion. In this controlled clinical study, RIPC failed to improve the profile of renal and cardiac biomarkers in patients with LEAD periprocedurally. RIPC significantly limits the rise in adiponectin levels and may influence the decrease of CK-MB levels 24 hours after endovascular procedure.

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Remote ischemic preconditioning reduces the incidence of contrast‐induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta‐analysis of randomized controlled trials

Cited by 10 publications

References 38 publications

Hypertensive status is associated with renoprotection by remote ischemic conditioning for acute myocardial infarction—a meta-regression and trial sequential analysis of randomized clinical trials

Hypertensive status is associated with renoprotection by remote ischemic conditioning for acute myocardial infarction—a meta-regression and trial sequential analysis of randomized clinical trials

Protective role of remote ischemic conditioning in renal transplantation and partial nephrectomy: A systematic review and meta-analysis of randomized controlled trials

The Role of RIPC in Preventing Organ Damage, Inflammation, and Oxidative Stress during Lower Limb DSA: A Randomised Controlled Trial

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