Protection of remote ischemic preconditioning against acute kidney injury: a systematic review and meta-analysis.
BACKGROUND
Remote ischemic preconditioning (RIPC) is a promising approach to preventing acute kidney injury (AKI), but its efficacy is controversial.


METHODS
A systematic review of 30 randomized controlled trials was conducted to investigate the effects of RIPC on the incidence and outcomes of AKI. Random effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity. The primary outcome was incidence of AKI and hospital mortality.


RESULTS
The total pooled incidence of AKI in the RIPC group was 11.5 %, significantly less than the 23.3 % incidence in the control group (P = 0.009). Subgroup analyses indicated that RIPC significantly reduced the incidence of AKI in the contrast-induced AKI (CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %, P = 0.173). Random effects meta-regression indicated that RIPC tended to strengthen its renoprotective effect (q = 3.95, df = 1, P = 0.047) in these trials with a higher percentage of diabetes mellitus. RIPC had no significant effect on the incidence of stages 1-3 AKI or renal replacement therapy, change in serum creatinine and estimated glomerular filtration rate (eGFR), hospital or 30-day mortality, or length of hospital stay. But RIPC significantly increased the minimum eGFR in the IR-AKI subgroup (P = 0.006) compared with the control group. In addition, the length of ICU stay in the RIPC group was significantly shorter than in the control group (2.6 vs 2.0 days, P = 0.003).


CONCLUSIONS
We found strong evidence to support the application of RIPC to prevent CI-AKI, but not IR-AKI.
Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, China.
Jiachang
J
Hu
Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, China.
Shaopeng
S
Liu
Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, China.
Ping
P
Jia
Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, China.
Xialian
X
Xu
Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, China.
Nana
N
Song
Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, China.|Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, 750004, China.
Ting
T
Zhang
Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, China.
Rongyi
R
Chen
Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China. ding.xiaoqiang@zs-hospital.sh.cn.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, China. ding.xiaoqiang@zs-hospital.sh.cn.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, China. ding.xiaoqiang@zs-hospital.sh.cn.
Xiaoqiang
X
Ding
D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D019194:Ischemic Preconditioning / Q000379:methods / Q000639:trends*; D007677:Kidney Function Tests; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data
Acute kidney injury; Cardiac surgery; Percutaneous coronary intervention; Remote ischemic preconditioning; Renal replacement therapy