title: The Impact of Remote Ischemic Pre-Conditioning on Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography and Angioplasty: A Double-Blind Randomized Clinical Trial.
abstract: OBJECTIVE
  Contrast-induced nephropathy (CIN) is an acute major complication following intravascular administration of iodinated contrast agents; however, the best approach for preventing CIN is not clear. Remote ischemic pre-conditioning (RIPC) is a new, non-pharmacological method that has been considered for the prevention of CIN following coronary angiography. This study assessed the effects of RIPC with four brief episodes of upper limb ischemia and reperfusion in the prevention of contrast-induced nephropathy (CIN) after coronary angiography and/or angioplasty.
  
  
  METHODS
  In this double-blind randomized clinical trial, we enrolled 51 patients with chronic stable angina and non-ST elevation acute coronary syndrome (NSTE.ACS), and they underwent coronary angiography and/or angioplasty. Standard fluid therapy with normal saline was prescribed for all patients before and after the procedure. The patients were divided into two groups, i.e., a study group of patients who had undergone RIPC intervention and a control group of patients who had not undergone RIPC. One hour before the procedure, a sphygmomanometer cuff was placed around one arm and inflated up to 50 mmHg above the systolic pressure for five minutes; then, the cuff was deflated for another five minutes, and this cycle was repeated four times. The patients' serum creatinine levels were measured at baseline and 48 hours after the procedure, and the incidence of CIN was calculated.
  
  
  RESULTS
  Twenty-one males and 30 females were studied in two groups, i.e., an RIPC intervention group (n = 25) and a control group (n = 26) that were homogenous considering baseline characteristics. No significant difference was observed in the mean level of serum creatinine between the two groups at a post-intervention time of 48 hours (RICP: 1.74 ± 0.70 mg/dL vs.
  
  
  METHODS
  1.75 ± 0.87 mg/dL; P = 0.64). However, a lower incidence rate of CIN was observed 48 hours after the administration of the contrast medium in the RIPC group, but it was not statistically significant (RIPC: 23.1% vs.
  
  
  METHODS
  12.0%; P = 0.30).
  
  
  CONCLUSIONS
  It seems that adequate fluid therapy is still the most effective strategy for preventing CIN and that RIPC might have additional protective effects in very high risk patients, such as those with severe renal insufficiency and heart failure.
authors.affiliation: MD, Assistant Professor, Department of Cardiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Gholoobi
authors.affiliation: MD, Resident of Cardiology, Department of Cardiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Seyyed Masoud
authors.initials: SM
authors.lastname: Sajjadi
authors.affiliation: MD, Professor, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mahmoud Mohammadzadeh
authors.initials: MM
authors.lastname: Shabestari
authors.affiliation: MD, Assistant Professor, Department of Cardiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Eshraghi
authors.affiliation: Medical Student, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Alireza Sepehri
authors.initials: AS
authors.lastname: Shamloo
keywords: contrast-induced nephropathy; coronary angiography; kidney diseases; percutaneous coronary intervention; remote ischemic pre-conditioning
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