title: Failure of remote ischemic preconditioning to reduce the risk of postoperative acute kidney injury in children undergoing operation for complex congenital heart disease: a randomized single-center study.
abstract: OBJECTIVE
  The objective of this study was to evaluate whether remote ischemic preconditioning can protect kidney function in children undergoing operation for complex congenital heart disease.
  
  
  METHODS
  Children (n = 113) aged 0 to 15 years admitted for complex congenital heart disease were randomly allocated according to age to remote ischemic preconditioning and control groups. After exclusion of 8 patients, we conducted the analysis on 105 patients (remote ischemic preconditioning group, n = 54; control group, n = 51). Before surgery, remote ischemic preconditioning was performed as 4 cycles of 5 minutes of ischemia by inflating a cuff around a leg to 40 mm Hg above the systolic pressure. End points were development of acute kidney injury, initiation of dialysis, plasma creatinine, estimated glomerular filtration rate, plasma cystatin C, plasma and urinary neutrophil gelatinase-associated lipocalin, and urinary output. Secondary end points included postoperative blood pressure, inotropic score, and mortality, as well as morbidity reflected by reoperation and stays in the intensive care unit and hospital.
  
  
  RESULTS
  Overall, 57 of the children (54%) had acute kidney injury develop, with 27 (50%) in the remote ischemic preconditioning group and 30 (59%) in the control group (P > .2). Remote ischemic preconditioning was not associated with improvement in either any of the renal biomarkers or any of the secondary end points.
  
  
  CONCLUSIONS
  We found no evidence that remote ischemic preconditioning provided protection of kidney function in children undergoing operation for complex congenital heart disease.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Århus University Hospital, Skejby, Århus, Denmark.
authors.forename: Kirsten Rønholt
authors.initials: KR
authors.lastname: Pedersen
authors.forename: Hanne Berg
authors.initials: HB
authors.lastname: Ravn
authors.forename: Johan Vestergaard
authors.initials: JV
authors.lastname: Povlsen
authors.forename: Michael Rahbek
authors.initials: MR
authors.lastname: Schmidt
authors.forename: Erland Jørn
authors.initials: EJ
authors.lastname: Erlandsen
authors.forename: Vibeke Elisabeth
authors.initials: VE
authors.lastname: Hjortdal
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control* / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000293:Adolescent; D015415:Biomarkers / Q000097:blood / Q000652:urine; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D003718:Denmark; D005260:Female; D005919:Glomerular Filtration Rate; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019194:Ischemic Preconditioning / Q000379:methods*; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D016013:Likelihood Functions; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011518:Proto-Oncogene Proteins / Q000652:urine; D006435:Renal Dialysis; D013997:Time Factors; D017211:Treatment Failure; D014554:Urination
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine