title: Remote Ischemic Preconditioning and Contrast-Induced Nephropathy: A Systematic Review.
abstract: BACKGROUND
  The use of imaging is increasing in clinical practice either for diagnosis or intervention. In these aims, contrast medium (CM) is widely used. However, CM administration can induce contrast-induced nephropathy (CIN). The incidence of CIN varies from 2% to 50% depending on patient risk factors, and CIN is the third cause of renal insufficiency. To date, methods such as hyperhydration to prevent CIN have a low level of evidence. Remote ischemic preconditioning (RIPC), which has already proved its efficiency in the cardiology field, seems to be a promising technique for CIN prevention. The aim of this work was to carry out a systematic review of the literature of the randomized clinical studies on RIPC in the prevention of CIN in man.
  
  
  METHODS
  We conducted a systematic review of randomized clinical studies on the RIPC in the prevention of CIN in man. Documentary sources were PubMed articles published until June 2015. Randomized clinical trials of RIPC in preventing CIN in human were reviewed.
  
  
  RESULTS
  Five articles were selected for the analysis. One article studied the impact of RIPC in a population at high risk of CIN, whereas the other 4 analyzed populations at low, moderate or unknown risk of CIN. In 4 studies, except the later one, the risk of CIN was based on the Mehran score that was previously published. In the high-risk population, a decrease in the incidence of CIN was found in the RIPC group compared with the control group (12% against 40%; P = 0.002). Among the 3 other studies using the Mehran's score, one also demonstrated the interest of such a procedure in a subgroup of high-risk patients. A second one found a low incidence of CIN in the RIPC group ([5 of 47; 10%] as compared with a control group [17 of 47; 36%] P = 0.003) in patients at the low risk of CIN. In another low-risk population, a significant lower level of a biological marker (liver-type fatty acid-binding protein) that assesses a renal impairment was found in the RIPC compared with the control group.
  
  
  CONCLUSIONS
  Only 5 studies were found in this search, which may constitute a limitation. However, RIPC appears as a promising method to prevent CIN since it is a noninvasive, low cost, easy, and safe method. More randomized controlled trials are needed to confirm these preliminary results.
authors.affiliation: Département d'imagerie, CHU de Rennes, Rennes, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Koch
authors.affiliation: INSERM, Centre d'investigation clinique, CIC 1414, Rennes, France.
authors.forename: Ségolène
authors.initials: S
authors.lastname: Chaudru
authors.affiliation: Département d'imagerie cœur-vaisseaux, CHU de Rennes, Rennes, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Lederlin
authors.affiliation: Département d'imagerie cœur-vaisseaux, CHU de Rennes, Rennes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Jaquinandi
authors.affiliation: INSERM, Laboratoire Traitement du Signal et de l'Image UMR 1099, University of Rennes 1, Rennes, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Kaladji
authors.affiliation: INSERM, Centre d'investigation clinique, CIC 1414, Rennes, France; Département d'imagerie cœur-vaisseaux, CHU de Rennes, Rennes, France. Electronic address: maheguillaume@yahoo.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Mahé
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D000975:Antioxidants / Q000008:administration & dosage; D003287:Contrast Media / Q000009:adverse effects*; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007683:Kidney Tubular Necrosis, Acute / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D012039:Regional Blood Flow; D012307:Risk Factors; D014111:Tourniquets; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*
chemical_list: D000975:Antioxidants; D003287:Contrast Media; D000111:Acetylcysteine