title: Remote ischemic preconditioning for renal protection during elective open infrarenal abdominal aortic aneurysm repair: randomized controlled trial.
abstract: We aimed to determine whether remote ischemic preconditioning (IP) reduces renal damage following elective open infrarenal abdominal aortic aneurysm (AAA) repair. Sequential common iliac clamping was used to induce remote IP in randomized patients. Urinary retinol binding protein (RBP) and albumin-creatinine ratio (ACR) were measured following induction and 3, 24, and 48 hours postoperatively. In controls (n = 22), median urinary RBP increased from 112 microg/mL (interquartile range [IQR] 96-173 microg/mL) preoperatively to 5919 microg/mL (IQR 283-17 788 microg/mL) at 3 hours. Preoperative urinary RBP in preconditioned patients was 96 microg/mL (IQR 50 to 229 microg/mL) preoperatively, rising to 1243 microg/mL (IQR 540 to 15400 microg/mL) at 3 hours. Although control patients' median urinary RBP level was 5 times greater at 3 hours, there were no statistically significant differences in renal outcome indices. This trial could not confirm that remote IP reduces renal injury following elective open aneurysm surgery.
authors.affiliation: Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, United Kingdom. srwalsh@doctors.org.uk
authors.forename: Stewart R
authors.initials: SR
authors.lastname: Walsh
authors.forename: Umar
authors.initials: U
authors.lastname: Sadat
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Boyle
authors.forename: Tjun Y
authors.initials: TY
authors.lastname: Tang
authors.forename: Marta
authors.initials: M
authors.lastname: Lapsley
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Norden
authors.forename: Michael E
authors.initials: ME
authors.lastname: Gaunt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000209:etiology; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015415:Biomarkers / Q000652:urine; D003250:Constriction; D003404:Creatinine / Q000652:urine; D017558:Elective Surgical Procedures; D004739:England; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control* / Q000652:urine; D019194:Ischemic Preconditioning / Q000379:methods; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012177:Retinol-Binding Proteins / Q000652:urine; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D012177:Retinol-Binding Proteins; D003404:Creatinine