title: Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery: a randomized controlled trial.
abstract: OBJECTIVE
  Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery.
  
  
  METHODS
  Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters.
  
  
  RESULTS
  There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group.
  
  
  CONCLUSIONS
  In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay.
authors.affiliation: Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yong Seon
authors.initials: YS
authors.lastname: Choi
authors.forename: Jae Kwang
authors.initials: JK
authors.lastname: Shim
authors.forename: Jong Chan
authors.initials: JC
authors.lastname: Kim
authors.forename: Kyu-Sik
authors.initials: KS
authors.lastname: Kang
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Seo
authors.forename: Ki-Ryang
authors.initials: KR
authors.lastname: Ahn
authors.forename: Young Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D019194:Ischemic Preconditioning; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D056910:Republic of Korea; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers