Remote ischemic preconditioning for prevention of contrast-medium-induced nephropathy: (RenoProtection-trial)

Abstract

BackgroundContrast-medium-induced acute kidney injury is associated with substantial morbidity and mortality. The underlying mechanism has been partially attributed to ischemic kidney injury. The aim of this randomized, double-blind, sham-controlled trial was to assess the impact of remote ischemic preconditioning on contrast-medium-induced acute kidney injury. MethodsPatients with impaired renal function (serum creatinine >1.4mg/dL and/or estimated glomerular filtration rate <60mL/min/1.73m2) undergoing elective coronary angiography were randomized in a 1:1 ratio to standard care with (n=50) or without ischemic preconditioning (n=50; intermittent arm ischemia through four cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff). Overall, both study groups were at high risk to develop contrast-medium-induced acute kidney injury using Mehran risk score. The primary endpoint was the incidence of contrast-medium-induced kidney injury, defined as an increase of serum creatinine ≥25% and/or ≥0.5mg/dL above baseline at 48h after contrast-medium exposure. ResultsContrast-medium-induced acute kidney injury occurred in 26 patients (26%), 20 (40%) in the control group and 6 (12%) in the remote ischemic preconditioning group (OR 0.21; 95% CI 0.07–0.57; P=0.002). No major adverse events were related to remote ischemic preconditioning. ConclusionsRemote ischemic preconditioning before contrast-medium use prevents contrast medium-induced acute kidney injury in high risk patients. Our findings merit a larger trial to establish remote ischemic preconditioning on clinical outcomes.