title: Renoprotection by remote ischemic conditioning during elective coronary revascularization: A systematic review and meta-analysis of randomized controlled trials.
abstract: Remote ischemic conditioning (RIC) has been recognized an emerging non-invasive approach for preventing acute kidney injury (AKI) in patients undergoing either elective coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). On the other hand, accumulating evidence has indicated the involving role of pre-CABG contrast usage for coronary angiography in post-surgery AKI risk. Along with the shortening time delay of CABG after coronary angiography, and the prevalent hybrid coronary revascularization (HCR), the AKI prevention by RIC has faced challenges following coronary revascuralization.
  
  
  
  Randomized controlled trials (RCTs) were searched from Pubmed, EMBase, and Cochrane library (until May 2016). The primary outcome was postoperative AKI. The second outcomes were included the requirement for renal replacement therapy (RRT), and in-hospital or 30-day mortality.
  
  
  
  Twenty eligible RCTs (CABG, 3357 patients; PCI, 1501 patients) were selected. RIC significantly halved the incidence of AKI following PCI when compared with controls [n=1501; odds ratio (OR)=0.51; 95% CI, 0.32 to 0.82; P=0.006; I(2)=29.6%]. However, RIC did not affect the incidence of AKI following CABG (n=1850; OR=0.94; 95% CI, 0.73 to 1.19; P=0.586; I(2)=12.4%). The requirement for RRT and in-hospital mortality was not affected by RIC in CABG (n=2049, OR=1.04, P=0.87; n=1920, OR=0.89, P=0.7; respectively).
  
  
  
  Our meta-analysis suggests that RIC for preventing AKI following CABG has faced with challenges in terms of AKI, the requirement for RRT, and mortality. However, RIC shows a renoprotective benefit for PCI. Hence, our findings may infer the preserved renal effects of RIC in CABG with preconditioning before the coronary angiography, or in HCR.
authors: Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
authors: Chenghui
authors: C
authors: Zhou
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Daehakro 101, Seoul 110-744, South Korea.
authors: Yunseok
authors: Y
authors: Jeon
authors: Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors: Patrick
authors: P
authors: Meybohm
authors: Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Münster, Albert- Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany.
authors: Alexander
authors: A
authors: Zarbock
authors: Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington 6242, New Zealand.
authors: Paul Jeffrey
authors: PJ
authors: Young
authors: Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. Electronic address: llhfw59@163.com.
authors: Lihuan
authors: L
authors: Li
authors: The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, United Kingdom; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore.
authors: Derek J
authors: DJ
authors: Hausenloy
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology / Q000517:prevention & control*; D017558:Elective Surgical Procedures / Q000379:methods* / Q000639:trends; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods* / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods*
keywords: Coronary artery bypass graft; Percutaneous coronary intervention; Remote ischemic conditioning; Renoprotection