Abstract
Introduction: 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. Methods: 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. Conclusion: 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.
Highlights
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
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
Summary
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. Contrast induced Acute Kidney Injury (CI-AKI) is a serious complication of iodinated contrast media used in Percutaneous Coronary Interventions. Its incidence is variably reported between 1-30% which makes it one of the most common causes of hospital-acquired acute kidney injury [1]. What constitutes a diagnostic threshold of serum creatinine rise in CI-AKI has been a contentious issue. Earlier publications used a cut off value of > 0.5 mg /dl increase of serum creatinine for diagnosing CI-AKI. A variety of preventive strategies have been investigated in an effort to decrease the incidence of CI-AKI. Fenoldopam, furosemide, mannitol, aminophylline, atrial natriuretic peptide, captopril, calcium channel blockers and alprostadil were not effective in preventing contrast-induced acute kidney injury (CI-AKI). Novel treatment strategies are required to prevent CI-AKI
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have