Abstract
The ability of remote ischemic preconditioning (RIPC) to prevent contrast-induced nephropathy (CIN) following percutaneous coronary angiography in at-risk patients is controversial. No evidence exists regarding potential RIPC positive effects on renal function and clinical outcomes in the long-term. The PREPARE study was a randomized, prospective, multicenter, and double-blinded trial. A total of 222 patients scheduled for coronary angiography and/or percutaneous transluminal coronary angioplasty with an estimated glomerular filtration rate (eGFR) < 40 mL/min/1.73 m2, or eGFR between 40 and 60 mL/min/1.73 m2 and two further risk factors were allocated to RIPC or control groups. Preventive measures were applied to all patients, including continuous intravenous saline infusion, withdrawal of nephrotoxic drugs, and limited volume of contrast medium. The primary endpoint, namely incidence of CIN, was 3.8% in the control group and 5.1% in the RIPC group (p = 0.74). The secondary endpoints, i.e., changes in serum creatinine and eGFR levels from baseline to 48 hours and from baseline to 12 months following contrast medium exposure, did not differ between both groups. The incidences of all major clinical events at 12 months were similar in both groups. In this population at risk of CIN, preventive strategies were associated with low CIN incidence. RIPC impacted neither the CIN incidence nor both the renal function and clinical outcomes at 1-year follow-up.
Highlights
Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired acute kidney injury[1], which has been associated with significant morbidity and mortality[2]
The renal PRotection against contrast mEdium-induced nephropaPAthy in patients at Risk undErgoing coronary angiography (PREPARE) trial was designed to determine if remote ischemic preconditioning (RIPC), when initiated before coronary angiography or percutaneous transluminal coronary angioplasty (PTCA), would reduce contrast-induced nephropathy (CIN) occurrence in patients at risk of CIN, and to assess its potential beneficial effects at 12 months
Inclusion criteria were: (1) patients scheduled for coronary angiography and/or percutaneous transluminal coronary angioplasty; (2) patients with an estimated glomerular filtration rate, determined using the modification of diet in renal disease (MDRD) formula,
Summary
Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired acute kidney injury[1], which has been associated with significant morbidity and mortality[2]. Defined as a relative 25% rise or 0.5 mg/dL increase in serum creatinine values compared with baseline within 48–72 hours after contrast medium administration, the CIN incidence (2–40%) highly depends on several risk factors, such as moderate-to-severe chronic renal impairment, age, diabetes mellitus, heart failure, shock, left ventricular systolic dysfunction, concomitant use of nephrotoxic drugs, large volumes of contrast agent, and anemia[3,4]. These risk factors are frequently associated in patients undergoing www.nature.com/scientificreports/. The renal PRotection against contrast mEdium-induced nephropaPAthy in patients at Risk undErgoing coronary angiography (PREPARE) trial was designed to determine if RIPC, when initiated before coronary angiography or PTCA, would reduce CIN occurrence in patients at risk of CIN, and to assess its potential beneficial effects at 12 months
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