Remote Ischemic Preconditioning in Prevention of Contrast Induced Nephropathy in Patients Undergoing Lower Limb Angioplasty Revascularization for Peripheral Arterial Disease: A Randomized Control Trial

Abstract

Background: Contrast induced nephropathy (CIN) following angiography is one of the leading causes of in-hospital acute kidney injury (AKI). The aim of this study was to investigate the renoprotective effect of remote ischemic preconditioning (RIPC) to prevent CIN in patients with peripheral arterial disease (PAD) undergoing lower limb angioplasty with standard preventative measures. Methods: 40 adult patients (eGFR >45 ml/min) undergoing peripheral arterial angioplasty received either: (1) Control: standard preventative measures comprising intravenous (IV) hydration with 0.9% normal saline (1ml/kg/hour) or (2) RIPC: four-5 min inflations and deflations of a pneumatic cuff placed on the upper arm in addition to IV hydration prior to the angiographic procedure. Serial measurements of serum creatinine, serum cystatin and urinary NGAL were taken at baseline and 2, 24, 48- and 72-hours post-procedure. The primary outcome was CIN as defined by a rise of creatinine by > 26.5umol/L above baseline within 48 hours of contrast exposure. Other outcome measures included the rise in urine NGAL and serum cystatin from base line at 2 hours, as an early marker of acute kidney injury (AKI). Results: Both groups had similar baseline characteristics. All recruited patients had eGFR >45 ml/min, and RIPC had no renoprotective effect. AKI occurred in five (13%) patients. Changes in serum creatinine at 2 hours post-procedure did not correlate with changes in urine NGAL or serum Cystatin C. Conclusion: In stable PAD patients (eGFR >45ml/min) undergoing lower limb angioplasty with standard preventative measures, RIPC did not offer any protection against development of CIN.