Effect of Remote Ischemic Preconditioning on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Endovascular Aneurysm Repair (Remote Ischemic Preconditioning–Endovascular Aneurysm Repair Study)

Abstract

Contrast-induced nephropathy (CIN) is a major inconvenience in the use of iodinated contrast media (ICM) and it is associated with a significant increase in morbidity and mortality and cost of hospitalization. Remote ischemic preconditioning (RIPC) is a noninvasive and cost-effective tissue protection technique that has showed to be beneficial in decreasing renal insult in patients receiving intravascular contrast. The primary outcome of this study is to evaluate the impact of RIPC on the incidence of CIN in patients undergoing endovascular aneurysm repair. Patients suffering from aortic aneurysm were recruited prior to the administration of ICM. Randomization was used to assign patients into the control/RIPC groups. Biochemical parameters determined renal function before and after surgery in immediate (24-72hr) and at 30days of follow-up. Of the 120 patients included in the study, 98,3% were male. Mean age was 73years (range: 56-87 years). Diabetes and chronic renal failure (considering estimated glomerular filtration [eGFR] <60) was present prior to administration of ICM in 29.16% and 38.33%, respectively. RIPC was applied in 50% (n=60) of the patients. A total of 24.17% developed CIN regardless of fluidotherapy, RIPC, and other protective strategies. RIPC did not influence outcomes in terms of incidence on CIN, serum creatinine, urea, eGFR, or microalbuminuria in immediate postoperative period. However, the group of RIPC patients showed a statistically significant benefit in renal function in terms of serum creatinine (1.46±0.3 vs. 1.03±0.5; P<0.001), urea (61.06±27.5mg/dL vs. 43.78±12.9mg/dL; P=0.003), and an increase in eGFR (56.37±23.4mL/min/1.73m2 vs. 72.85±17.7mL/min/1.73m2; P=0.004) at 30days of follow-up. RIPC seems to be a reasonable, effective, and low-cost technique to alleviate effects of ICM on the renal parenchyma in endovascular aneurysm repair procedures during short-term postoperative period.