Nephroprotective effects of remote ischemic preconditioning in coronary angiography.
BACKGROUND
Contrast-induced nephropathy (CIN) is a formidable side effect of iodinated contrast medium use in subjects undergoing coronary angiogram (CAG). Remote ischemic preconditioning (RIPC) may reduce the risk of CIN.


OBJECTIVE
The aim of the study was to investigate the nephroprotective effects of RIPC in coronary heart disease (CHD) in patients, undergoing CAG, with mild to moderate lowered estimated glomerular filtration rate (eGFR).


METHODS
In the randomized, blinded, sham RIPC (sRIPC) controlled study 51 patients with CHD and GFR less than 80 mL/min/m2, undergoing CAG, were investigated. The patients were randomized for RIPC (n = 26, 60.5±2.0 years) or sRIPC (n = 25, 62.96±1.7). RIPC was performed before the CAG by means of 3-5-minute cycle cuff pumped on the upper arm + 50 mm Hg above the systolic blood pressure (BP), while in sRIPC it corresponded to diastolic BP. The primary endpoint was the development of CIN and secondary - change of biomarkers (creatinine, urea, neutrophil gelatinase-associated lipocalin (NGAL), cystatin-C).


RESULTS
In RIPC group, CIN occurred in 28% of cases, while in sRIPC - 3.8%. All investigated markers increased in sRIPC and declined in RIPC; the difference was significant in markers between the groups before and after CAG.


CONCLUSIONS
RIPC proved nephroprotective effect in prevention of contrast-induced nephropathy in CHD subjects with mild to moderate lowered eGFR.
Department of Internal Diseases, Bashkir State Medical University, Ufa, Russian Federation.
Naufal Shamilevich
NS
Zagidullin
Department of Internal Diseases, Bashkir State Medical University, Ufa, Russian Federation.
Alina Rinatovna
AR
Dunayeva
Department of Surgery, Bashkir State Medical University, Ufa, Russian Federation.
Valdimir Vyacheslavovich
VV
Plechev
Department of Laboratory Diagnostics, Bashkir State Medical University, Ufa, Russian Federation.
Alexander Zhanovich
AZ
Gilmanov
Department of Internal Diseases, Bashkir State Medical University, Ufa, Russian Federation.
Shamil Zarifovich
SZ
Zagidullin
Department of Internal Diseases, Klinikum Gütersloh, Department of Cardiology and Electrophysiology, Gutersloch, Germany.
Fikret
F
Er
Department of Urology, Bashkir State Medical University, Ufa, Russian Federation.
Valentin Nikolaevich
VN
Pavlov
D058186:Acute Kidney Injury / Q000209:etiology* / Q000473:pathology; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
CIN; NGAL; RIPC; cystatin