Remote ischemic preconditioning to reduce contrast-induced nephropathy: study protocol for a randomized controlled trial.
BACKGROUND
Despite the increasing use of pre- and posthydration protocols and low-osmolar instead of high-osmolar iodine-containing contrast media, the incidence of contrast-induced nephropathy (CIN) is still significant. There is evidence that contrast media cause ischemia-reperfusion injury of the medulla. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low-cost method to reduce ischemia-reperfusion injury.


METHODS
The RIPCIN study is a multicenter, single-blinded, randomized controlled trial in which 76 patients at risk of CIN will receive standard hydration combined with RIPC or hydration with sham preconditioning. RIPC will be applied by four cycles of 5 min ischemia and 5 min reperfusion of the forearm by inflating a blood pressure cuff at 50 mmHg above the actual systolic pressure. The primary outcome measure will be the change in serum creatinine from baseline to 48 to 72 h after contrast administration.


CONCLUSIONS
A recent pilot study reported that RIPC reduced the incidence of CIN after coronary angioplasty. The unusual high incidence of CIN in this study is of concern and limits its generalizability. Therefore, we propose a randomized controlled trial to study whether RIPC reduces contrast-induced kidney injury in patients at risk for CIN according to the Dutch guidelines.


BACKGROUND
Current Controlled Trials ISRCTN76496973.
Thomas B
TB
Sterenborg
Theo P
TP
Menting
Yvonne
Y
de Waal
Rogier
R
Donders
Kimberley E
KE
Wever
M Susan
MS
Lemson
Daan J A
DJ
van der Vliet
Jack F
JF
Wetzels
Leo J
LJ
SchultzeKool
Department of Surgery, Division of Vascular- and Transplant Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Zuid 10, Nijmegen, GA 6525, the Netherlands. m.warle@chir.umcn.nl.
Michiel C
MC
Warlé
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003287:Contrast Media / Q000009:adverse effects*; D005440:Fluid Therapy; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D015427:Reperfusion Injury / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012107:Research Design; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media