title: Remote Ischemic Conditioning for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions/Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  It is uncertain whether remote ischemic conditioning (RIC) has a protective effect on contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI)/coronary artery angiography (CAG). We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of RIC on CI-AKI in such patients.
  
  
  METHODS
  PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials databases were searched for RCTs that assessed the effect of RIC on CI-AKI in patients undergoing PCI/CAG.
  
  
  RESULTS
  Ten RCTs with 1389 patients (RIC group, 757 and control, 632) were included. The RIC group significantly exerted a lower risk of CI-AKI compared to the controls (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.34-0.77, P = .001), and they had the similar effect on major adverse cardiovascular events within 1 year (OR = 0.36, 95% CI = 0.20-0.66, P < .001). The RIC reduced the rates of death within 30 days, but this was not significant (OR = 0.16, 95% CI = 0.02-1.34, P = .091). The RIC was associated with a significantly lower incidence of CI-AKI in patients following elective PCI/CAG (OR = 0.54, 95% CI = 0.33-0.87, P = .011). The RIC before not after the intervention was effective in reducing the occurrence of CI-AKI (OR: 0.37 vs 1.05, P = .022). The RIC of the upper arm has statistically significant effect on protecting CI-AKI but not that of the lower limb (OR: 0.41 vs 1.41, P = .004). The effect of RIC on CI-AKI was similar between patients with a mean estimated glomerular filtration rate <60 mL/min/1.73 m(2) and those with mean rates ≥60 (OR: 0.23 vs 0.41, P = .333).
  
  
  CONCLUSIONS
  The RIC reduced the incidence of CI-AKI in those receiving PCI/CAG. And RIC of the upper arm significantly reduced the risk of CI-AKI but not RIC of the lower limb in patients undergoing PCI/CAG.
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
authors.forename: Wei-jie
authors.initials: WJ
authors.lastname: Bei
authors.affiliation: Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou Guangdong, China.
authors.forename: Chong-yang
authors.initials: CY
authors.lastname: Duan
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
authors.forename: Ji-yan
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China The authors are considered equally as corresponding authors.
authors.forename: Yuan-hui
authors.initials: YH
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China The authors are considered equally as corresponding authors.
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China The authors are considered equally as corresponding authors tanning100@126.com lyh0718@126.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Tan
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D019194:Ischemic Preconditioning / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D065840:Protective Factors; D016032:Randomized Controlled Trials as Topic; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*
chemical_list: D003287:Contrast Media
keywords: contrast-induced acute kidney injury; coronary angiography; meta-analysis; percutaneous coronary interventions; remote ischemic conditioning