title: Remote ischemic preconditioning for prevention of acute kidney injury: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Remote ischemic preconditioning (RIPC) to prevent acute kidney injury (AKI) following cardiac and vascular interventions is a controversial practice.
  
  
  METHODS
  We conducted a systematic review and meta-analysis using the MEDLINE database (1966 through November 2013), EMBASE (1988 through November 2013), and Cochrane Library database.
  
  
  METHODS
  Patients undergoing cardiac and vascular interventions.
  
  
  METHODS
  Randomized controlled trials comparing patient outcome with or without RIPC for prevention of AKI following cardiac and vascular interventions.
  
  
  METHODS
  RIPC using an inflatable tourniquet around the limb or cross-clamping the iliac arteries versus non-RIPC.
  
  
  RESULTS
  AKI, need for renal replacement therapy, postoperative kidney biomarkers, in-hospital mortality, and length of intensive care unit and hospital stay.
  
  
  RESULTS
  13 trials (1,334 participants) were included. RIPC decreased the risk of AKI for patients undergoing cardiac and vascular interventions compared with the control group (11 trials; 1,216 participants; risk ratio [RR], 0.70; 95% CI, 0.48-1.02; P = 0.06; I(2) = 45%) with marginal statistical significance. There were no differences in levels of postoperative kidney biomarkers (serum creatinine and glomerular filtration rate), incidence of renal replacement therapy, in-hospital mortality, hospital stay, or intensive care unit stay between the 2 groups. Metaregression analysis indicated that contrast intervention was not a covariate contributing significantly to heterogeneity on the risk estimate for AKI incidence; also, there was no dose effect of RIPC using tourniquet cuff around the limb on AKI prevention based on different ischemia duration.
  
  
  CONCLUSIONS
  Different AKI definitions adopted in the trials included.
  
  
  CONCLUSIONS
  RIPC might be beneficial for the prevention of AKI following cardiac and vascular interventions, but the current evidence is not robust enough to make a recommendation. Adequately powered trials are needed to provide more evidence in the future.
authors: Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors: Yi
authors: Y
authors: Yang
authors: Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors: Xia-Bing
authors: XB
authors: Lang
authors: Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors: Ping
authors: P
authors: Zhang
authors: Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors: Rong
authors: R
authors: Lv
authors: Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, and Centre for Genomic Sciences, the University of Hong Kong, Hong Kong.
authors: Yong-Fei
authors: YF
authors: Wang
authors: Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China. Electronic address: chenjianghua@zju.edu.cn.
authors: Jiang-Hua
authors: JH
authors: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007668:Kidney / Q000098:blood supply; D007677:Kidney Function Tests; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic
keywords: Remote ischemic preconditioning (RIPC); acute kidney injury (AKI); acute renal failure; cardiac and vascular interventions; meta-analysis; renal impairment