Abstract
Introduction: Contrast-induced acute kidney injury (CI-AKI) is a known complication of cardiac interventions. Remote ischemic preconditioning (RIPC) is a non-pharmacological method which has a nephroprotective effect. Serum cystatin C (CysC) is a suitable biomarker for the early diagnosis of AKI. Objectives: This study aimed to evaluate the incidence of CI-AKI after RIPC in patients undergoing coronary angiography, through assessment of CysC. Patients and Methods: Around 140 patients with stable coronary artery disease undergoing angiography were randomly allocated to two groups of RIPC and control groups. In each group, the following biomarkers were assessed: serum creatinine (Cr) and CysC at baseline, 24-hour and 48-hour serum Cr and 24-hour CysC. The endpoint was the development of AKI based on either the KDIGO criteria or a 15% increase in serum CysC. Results: No significant difference was observed between two groups regarding the incidence of AKI according to either KIDIGO criteria or by the increase of serum CysC (P =0.116 and P =0.392, respectively). Moreover, a 46.99% increase in CysC level was observed among patients with AKI during the first 24 hours after the procedure, while at the same interval, it increased only 16.01% in patients without AKI. Conclusion: RIPC with three cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease serum CysC based CI-AKI or alter renal biomarkers course in patients with low risk, who underwent coronary angiography.
Highlights
Contrast-induced acute kidney injury (CI-Acute kidney injury (AKI)) is a known complication of cardiac interventions
Contrast-induced acute kidney injury (CI-AKI) can be independently predicted by serum concentration of cystatin C (CysC) or its ratio to creatinine [12], while it has been suggested that changes in CysC concentration can be a better biomarker for early diagnosis of CI-AKI in comparison to serum creatinine [13]
Clinical results Of 140 patients, 11 patients were diagnosed with CI-AKI by the KIDIGO, 8 in the Remote ischemic preconditioning (RIPC) group and 3 cases of AKI in the control group
Summary
Acute kidney injury (AKI) is a sudden renal failure within few hours to few days, causing the retention of toxic products that are normally excreted by the kidneys [1]. AKI is a known complication after cardiac interventions since up to 30% of patients develop acute kidney damage. Contrast-induced acute kidney injury (CI-AKI) is a common cause of AKI in hospitalized patients, which is characterized by increased serum creatinine 48-72 hours after exposure to iodine-containing contrast medium. Remote ischemic preconditioning (RIPC), is a protective intervention based on ischemic conditioning response It has shown promising results in reducing the incidence of CI-AKI and mortality associated with this complication, its long-term effect on kidney function is not clear [8]. Serum creatinine has several limitations mainly its inability for early renal dysfunction diagnosis This led to numerous studies to find some biomarkers for early identification and treating of the CI-AKI [10]. CI-AKI can be independently predicted by serum concentration of CysC or its ratio to creatinine [12], while it has been suggested that changes in CysC concentration can be a better biomarker for early diagnosis of CI-AKI in comparison to serum creatinine [13]
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