The role of remote ischemic preconditioning on postoperative kidney injury in patients undergoing cardiac and vascular interventions: a meta-analysis

Abstract

The objective of this study was to perform a meta-analysis of randomized controlled trials (RCTs) investigating whether a remote ischemic preconditioning (RIPC) protocol provides renal protection to patients undergoing cardiac and vascular interventions. Searches were conducted in the databases PUBMED, EMBASE and Cochrane Library. RCTs that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed. We identified ten studies with a total of 924 patients undergoing cardiac and vascular interventions with or without RIPC. There was a significantly lower incidence of acute kidney injury in the RIPC group compared with control group using the fixed effect model (RR 0.69, 95% CI 0.53 to 0.90, P = 0.007), but not with the random effects model (RR 0.73, 95% CI 0.50 to 1.06, P = 0.10). There was no difference in the levels of renal biomarkers, incidence of renal replacement therapy, mortality, hospital stay, and intensive care unit stay between two groups. In conclusion, there is no enough evidence that RIPC provided renal protection in patients undergoing cardiac and vascular interventions. Large-scale RCTs are necessary to confirm the potential role of RIPC on renal impairment.

Marked protection against acute renal and hepatic injury after nitrited myoglobin + tin protoporphyrin administration

“…Notable in this regard is so called “remote preconditioning”, whereby recurrent bouts of upper and/or lower limb ischemia are induced by recurrently inflating and deflating blood pressure cuffs (24–26). The goal to release unknown tissue ‘conditioning factors’ into the systemic circulation that will trigger protective tissue responses (e.g., in brain, heart, liver, and kidney).…”

“…The goal to release unknown tissue ‘conditioning factors’ into the systemic circulation that will trigger protective tissue responses (e.g., in brain, heart, liver, and kidney). Despite its appeal, this approach has had only questionable success (24–26), likely due to the following: 1) the ‘factors’ released from post ischemic limbs that might induce ‘preconditioning’, and how much ‘factor’ release is required to induce this state, are unknown; 2) the cellular pathways by which such ‘factors’ impact distant organs to induce cytoresistance have not been defined; and 3) it is impossible to judge whether the desired ‘pre-conditioning’ actually develops in any given individual.…”

Acute kidney injury inChina

“…A more practical approach may be achieved using remote IPC (RIPC). RIPC has been shown to provide renal protection to patients undergoing cardiac and vascular interventions . Recently a group of Chinese urologists reported that slight lower limb ischemia significantly reduced renal impairment within 1 month after laparoscopic partial nephrectomy .…”

Does Remote Ischaemic Preconditioning Protect Kidney and Cardiomyocytes After Coronary Revascularization? A Double Blind Controlled Clinical Trial

“…Li L in a review study indicated that the main reason for the contradicting results in RIPC studies is different definition for AKIA (23). Brevoord also reviewed the literatures for renal protective role of RIPC after heart surgery.…”

“…He also concluded no difference between RIPC and control group. He indicated that as serum creatinine is the mostly used biomarker for detecting AKI (23-25), which might not change significantly in an acute setting. we have also observed its significant decrease after 24 hours.…”