title: Remote ischemic preconditioning does not affect the incidence of acute kidney injury after elective abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Open abdominal aortic aneurysm (AAA) repair is associated with a high risk of renal injury with few known strategies demonstrating a reduction in this risk. Remote ischemic preconditioning (RIPC) has been identified as having the potential to minimize organ injury following major vascular surgery. This trial investigated the potential for RIPC to attenuate renal and myocardial injury in patients undergoing elective open AAA repair.
  
  
  METHODS
  Prospective, randomized double-blinded control trial.
  
  
  METHODS
  Tertiary referral hospital.
  
  
  METHODS
  Sixty-two patients undergoing elective open AAA repair.
  
  
  METHODS
  RIPC was achieved via three 5-minute cycles of upper limb ischemia using a blood pressure cuff or control (sham cuff).
  
  
  METHODS
  Primary outcome was the occurrence of renal injury, as measured by an increase in creatinine during the first 4 postoperative days. Secondary outcomes included urinary neutrophil-gelatinase-associated lipocalin (NGAL), occurrence of acute kidney injury (AKI), occurrence of myocardial injury as defined by troponin rise, incidence of postoperative complications, and mortality. There was no difference in postoperative creatinine levels, NGAL levels, or the occurrence of AKI between the groups at any postoperative time point. Similarly, there was no difference in the occurrence of myocardial injury or mortality. Of note, 6 patients in the RIPC group, while no patient in the control group, experienced postoperative complications that required repeat surgical laparotomy, potentially masking any renoprotective effects of RIPC.
  
  
  CONCLUSIONS
  RIPC did not reduce the risk of postoperative renal failure or myocardial injury in patients undergoing open AAA repair. The authors' results do not support the introduction of this technique to routine clinical practice.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, St. Vincent's University Hospital, Dublin, Ireland. Electronic address: murphy.noelle@gmail.com.
authors.forename: Noelle
authors.initials: N
authors.lastname: Murphy
authors.affiliation: Anaesthesia and Intensive Care Medicine, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, East Yorkshire, UK.
authors.forename: Ajith
authors.initials: A
authors.lastname: Vijayan
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Frohlich
authors.affiliation: Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: O'Farrell
authors.affiliation: Vascular Surgery, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Barry
authors.affiliation: Vascular Surgery, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sheehan
authors.affiliation: Anaesthesia, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Boylan
authors.affiliation: Anaesthesia, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Conlon
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods* / Q000639:trends; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D011446:Prospective Studies
keywords: acute kidney injury; aortic aneurysm; remote ischemic preconditioning; vascular surgery