title: Remote ischemic preconditioning in hemodialysis: a pilot study.
abstract: Hemodialysis (HD)-induced myocardial ischemia is associated with an elevated cardiac troponin T, and is common in asymptomatic patients undergoing conventional HD. Remote ischemic preconditioning (RIPC) has a protective effect against myocardial ischemia-reperfusion injury. We hypothesized that RIPC also has a protective effect on HD-induced myocardial injury. Chronic HD patients were randomized to the control group or the RIPC group. RIPC was induced by transient occlusion of blood flow to the arm with a blood-pressure cuff for 5 min, followed by 5 min of deflation. Three cycles of inflation and deflation were undertaken before every HD session for 1 month (total 12 times). The primary outcome was the change in cardiac troponin T (cTnT) level at day 28 from baseline. Demographic and baseline laboratory values were not different between the control (n = 17) and the RIPC groups (n = 17). cTnT levels tended to decrease from day 2 in the RIPC group through to 28 days, in contrast to no change in the control group. There were significant differences in the change of cTnT level at day 28 from baseline [Control, median; -0.002 ng/ml (interquartile range -0.008 to 0.018) versus RIPC, median; -0.015 ng/ml (interquartile range -0.055 to 0.004), P = 0.012]. RIPC reduced cTnT release in chronic conventional HD patients, suggesting that this simple, cheap, safe, and well-tolerated procedure has a protective effect against HD-induced ischemia.
authors.affiliation: Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea.
authors.forename: Jongha
authors.initials: J
authors.lastname: Park
authors.forename: Soe Hee
authors.initials: SH
authors.lastname: Ann
authors.forename: Hyun Chul
authors.initials: HC
authors.lastname: Chung
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Lee
authors.forename: Shin-Jae
authors.initials: SJ
authors.lastname: Kim
authors.forename: Scot
authors.initials: S
authors.lastname: Garg
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Shin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010865:Pilot Projects; D011446:Prospective Studies; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000009:adverse effects*; D056910:Republic of Korea; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D034941:Upper Extremity / Q000098:blood supply*
chemical_list: D015415:Biomarkers; D020107:Troponin T