title: Remote Ischemic Preconditioning for the Prevention of Contrast-Induced Acute Kidney Injury in Diabetics Receiving Elective Percutaneous Coronary Intervention.
abstract: OBJECTIVE
  Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a subsequent ischemia-reperfusion injury. When RIPC is applied before percutaneous coronary intervention (PCI), the kidneys may be protected against ischemia-reperfusion injury and subsequently contrast-induced acute kidney injury (CI-AKI). The aim of this study was to evaluate the efficacy of RIPC for the prevention of CI-AKI in patients with diabetes with pre-existing chronic kidney disease (CKD) undergoing elective PCI.
  
  
  METHODS
  This randomized, double-blind, sham-controlled study enrolled patients with diabetes scheduled for elective PCI with eGFR ≤60 ml/min/1.73 m2 or urinary albumin creatinine ratio of >300 mg/g to receive either RIPC or the sham ischemic preconditioning.
  
  
  RESULTS
  One hundred and two patients (68.9 ± 8.2 years old, 47.1% men) were included. Baseline eGFR, creatinine and serum NGAL was similar between RIPC and control groups (48.5 ± 12 ml/min vs. 46.6 ± 10 ml/min, p = 0.391; 1.42 ± 0.58 mg/dl vs. 1.41 ± 0.34 mg/dl, p = 0.924; and 136.0 ± 45.0 ng/ml vs. 137.6 ± 43.3 ng/ml, p = 0.961, respectively). CI-AKI occurred in 13.7% (14/102) of the total subjects, with both RIPC and control groups having an equal incidence of 13.7% (7/51). No significant differences were seen in creatinine, NGAL, cardiac enzymes (troponin T, CKMB) and hs-CRP between the groups post-procedure.
  
  
  CONCLUSIONS
  In this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02329444.
authors.affiliation: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Gillian
authors.initials: G
authors.lastname: Balbir Singh
authors.affiliation: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Soe Hee
authors.initials: SH
authors.lastname: Ann
authors.affiliation: Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Jongha
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Hyun Chul
authors.initials: HC
authors.lastname: Chung
authors.affiliation: Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Division of Endocrinology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Eun-Sook
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Division of Endocrinology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Jung Il
authors.initials: JI
authors.lastname: Choi
authors.affiliation: Department of Occupational & Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Jiho
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Shin-Jae
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Shin
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D003287:Contrast Media / Q000009:adverse effects*; D003327:Coronary Disease / Q000628:therapy; D052279:Creatine Kinase, MB Form / Q000097:blood; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019194:Ischemic Preconditioning; D007668:Kidney / Q000098:blood supply; D000071068:Lipocalin-2 / Q000097:blood; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D020107:Troponin T / Q000097:blood
chemical_list: D003287:Contrast Media; D000071068:Lipocalin-2; D020107:Troponin T; D002097:C-Reactive Protein; D003404:Creatinine; D052279:Creatine Kinase, MB Form