Ischemic preconditioning for prevention of contrast medium-induced nephropathy: randomized pilot RenPro Trial (Renal Protection Trial).
BACKGROUND
Contrast medium-induced acute kidney injury is associated with substantial morbidity and mortality. The underlying mechanism has been attributed in part to ischemic kidney injury. The aim of this randomized, double-blind, sham-controlled trial was to assess the impact of remote ischemic preconditioning on contrast medium-induced acute kidney injury.


RESULTS
Patients with impaired renal function (serum creatinine >1.4 mg/dL or estimated glomerular filtration rate <60 mL · min(-1) · 1.73 m(-2)) undergoing elective coronary angiography were randomized in a 1:1 ratio to standard care with (n=50) or without ischemic preconditioning (n=50; intermittent arm ischemia through 4 cycles of 5-minute inflation and 5-minute deflation of a blood pressure cuff). Overall, both study groups were at high risk of developing contrast medium-induced acute kidney injury according to the Mehran risk score. The primary end point was the incidence of contrast medium-induced kidney injury, defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dL above baseline at 48 hours after contrast medium exposure. Contrast medium-induced acute kidney injury occurred in 26 patients (26%), 20 (40%) in the control group and 6 (12%) in the remote ischemic preconditioning group (odds ratio, 0.21; 95% confidence interval, 0.07-0.57; P=0.002). No major adverse events were related to remote ischemic preconditioning.


CONCLUSIONS
Remote ischemic preconditioning before contrast medium use prevents contrast medium-induced acute kidney injury in high-risk patients. Our findings merit a larger trial to establish the effect of remote ischemic preconditioning on clinical outcomes.


BACKGROUND
URL: http://www.germanctr.de. Unique identifier: U1111-1118-8098.
Department of Internal Medicine III, University of Cologne, Germany. Fikret.Er@uk-koeln.de
Fikret
F
Er
Amir M
AM
Nia
Henning
H
Dopp
Martin
M
Hellmich
Kristina M
KM
Dahlem
Evren
E
Caglayan
Torsten
T
Kubacki
Thomas
T
Benzing
Erland
E
Erdmann
Volker
V
Burst
Natig
N
Gassanov
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000401:mortality / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply; D015924:Blood Pressure Monitors; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010865:Pilot Projects; D012307:Risk Factors
D003287:Contrast Media; D003404:Creatinine