title: Effect of remote ischaemic conditioning on contrast-induced nephropathy in patients undergoing elective coronary angiography (ERICCIN): rationale and study design of a randomised single-centre, double-blind placebo-controlled trial.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN), an acute kidney injury resulting from the administration of intravascular iodinated contrast media, is an important cause of morbidity/mortality following coronary angiographic procedures in high-risk patients. Despite preventative measures intended to mitigate the risk of CIN, there remains a need for an effective intervention. Remote ischaemic conditioning (RIC), where non-injurious ischaemia is applied to an arm prior to the administration of contrast, has shown promise in attenuating CIN but its effectiveness in preserving long-term renal function is unknown, which will be studied as part of the effect of remote ischaemic conditioning against contrast-induced nephropathy (ERICCIN) trial. ( http://Controlled-trials.com Identifier: ISRCTN49645414.)
  
  
  METHODS
  The ERICCIN trial is a single-centre, randomised double-blinded placebo-controlled trial which plans to recruit 362 patients who are at risk of CIN, defined by pre-existent renal impairment (estimated glomerular filtration rate <60 ml/min/1.73 m2), over a period of 2 years. Patients will be randomised to either control or RIC consisting of 4, 5 min 200 mmHg balloon-cuff inflation/deflations, to the upper arm. The primary endpoint will be the development of CIN (>25% of eGFR, or rise of creatinine of >44 μmol/l) at 48 h. A key secondary endpoint will be whether RIC impacts upon persistent renal impairment over the 3-month follow-up period. Additional secondary endpoints include the measurement of serum neutrophil gelatinase-associated lipocalin and urinary albumin at 6, 48 h and 3 months following administration of contrast.
  
  
  CONCLUSIONS
  Findings from ERICCIN trial will potentially demonstrate that RIC attenuates contrast-induced acute and chronic kidney injury and influence future clinical practice guidelines in at-risk patients undergoing coronary angiographic procedures.
authors.affiliation: The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bell
authors.forename: Roger
authors.initials: R
authors.lastname: Rear
authors.forename: John
authors.initials: J
authors.lastname: Cunningham
authors.forename: Anne
authors.initials: A
authors.lastname: Dawnay
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D000209:Acute-Phase Proteins; D000419:Albuminuria / Q000139:chemically induced / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood; D002985:Clinical Protocols; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood; D008131:London; D011518:Proto-Oncogene Proteins / Q000097:blood; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D034941:Upper Extremity / Q000098:blood supply*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D003287:Contrast Media; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine