title: Remote-conditioning ischemia provides a potential approach to mitigate contrast medium-induced reduction in kidney function: a retrospective observational cohort study.
abstract: Contrast medium administration during imaging and therapeutic procedures can cause renal injury, partly due to ischemia. Therefore, we hypothesized that brief ischemia and reperfusion episodes applied at a distant site - multiple balloon inflations and deflations during angioplasty - may serve as a remote-conditioning (RC) stimulus and thereby protect against contrast-induced kidney injury. To test this hypothesis, we (1) utilized cases from a prior study in which patients undergoing emergent angioplasty for ST segment elevation myocardial infarction received either 1-3 balloon inflations (controls) or were 'conditioned' with multiple (≥4) inflations, and (2) assessed renal function for 3 days in patients with an estimated glomerular filtration rate (eGFR) of <90 ml/min/1.73 m(2) prior to revascularization (mild kidney disease). Both groups displayed increased eGFR at day 1 after angioplasty versus baseline; attributed to in-hospital hydration (control: 77 ± 14 vs. 68 ± 12 ml/min/1.73 m(2); p < 0.01; RC: 81 ± 21 vs. 69 ± 12 ml/min/1.73 m(2); p < 0.01). In controls, this improvement was transient: eGFR subsequently decreased to 70 ± 14 ml/min/1.73 m(2) at day 3 (p < 0.05). In contrast, the RC group (despite receiving 25% more contrast volume) showed no functional decline at day 3 (80 ± 14 ml/min/1.73 m(2)). These results are consistent with remote ischemic conditioning providing a novel potential approach to attenuate contrast-associated renal injury.
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit, Mich., USA. pwhittak@med.wayne.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Whittaker
authors.forename: Karin
authors.initials: K
authors.lastname: Przyklenk
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D001806:Blood Urea Nitrogen; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography / Q000379:methods; D004630:Emergencies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy*; D011379:Prognosis; D011859:Radiography; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D003404:Creatinine