Abstract
The objective of this study was to perform a meta-analysis of randomized controlled trials (RCTs) investigating whether a remote ischemic preconditioning (RIPC) protocol provides renal protection to patients undergoing cardiac and vascular interventions. Searches were conducted in the databases PUBMED, EMBASE and Cochrane Library. RCTs that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed. We identified ten studies with a total of 924 patients undergoing cardiac and vascular interventions with or without RIPC. There was a significantly lower incidence of acute kidney injury in the RIPC group compared with control group using the fixed effect model (RR 0.69, 95% CI 0.53 to 0.90, P = 0.007), but not with the random effects model (RR 0.73, 95% CI 0.50 to 1.06, P = 0.10). There was no difference in the levels of renal biomarkers, incidence of renal replacement therapy, mortality, hospital stay, and intensive care unit stay between two groups. In conclusion, there is no enough evidence that RIPC provided renal protection in patients undergoing cardiac and vascular interventions. Large-scale RCTs are necessary to confirm the potential role of RIPC on renal impairment.
Highlights
Acute kidney injury (AKI) affects up to 45% of patients undergoing cardiac surgery, percutaneous coronary intervention, and vascular surgery, and requires postoperative renal replacement therapy in nearly 1 to 2% [1,2]
Study characteristics A total of 924 participants were enrolled in the ten studies, including six studies in patients undergoing cardiac surgery, one studies in percutaneous coronary intervention, and three studies in vascular surgery. 464 patients were randomised to the remote ischemic preconditioning (RIPC) group, and 460 to the control group
The meta-analyses by D’Ascenzo et al [29] and Brevoord et al [30] which evaluated the effect of RIPC in the patients undergoing cardiac and vascular interventions concluded that serum creatinine levels were both not reduced by RIPC
Summary
Acute kidney injury (AKI) affects up to 45% of patients undergoing cardiac surgery, percutaneous coronary intervention, and vascular surgery, and requires postoperative renal replacement therapy in nearly 1 to 2% [1,2]. The kidneys are not directly exposed to ischemia-reperfusion injury, RIPC might preserve kidney function in patients undergoing cardiac and vascular interventions through blocking free radical production and attenuating the inflammatory response involved in pathogenesis of AKI [6,7,14]. This technique of RIPC has significant potential to decrease ischemic injury of other organs in patients undergoing cardiac and vascular interventions
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