title: Long-term Effects of Remote Ischemic Preconditioning on Kidney Function in High-risk Cardiac Surgery Patients: Follow-up Results from the RenalRIP Trial.
abstract: BACKGROUND
  In a multicenter, randomized trial, the authors enrolled patients at high-risk for acute kidney injury as identified by a Cleveland Clinic Foundation score of 6 or more. The authors enrolled 240 patients at four hospitals and randomized them to remote ischemic preconditioning or control. The authors found that remote ischemic preconditioning reduced acute kidney injury in high-risk patients undergoing cardiac surgery. The authors now report on the effects of remote ischemic preconditioning on 90-day outcomes.
  
  
  METHODS
  In this follow-up study of the RenalRIP trial, the authors examined the effect of remote ischemic preconditioning on the composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction at 90 days. Secondary outcomes were persistent renal dysfunction and dialysis dependence in patients with acute kidney injury.
  
  
  RESULTS
  Remote ischemic preconditioning significantly reduced the occurrence of major adverse kidney events at 90 days (17 of 120 [14.2%]) versus control (30 of 120 [25.0%]; absolute risk reduction, 10.8%; 95% CI, 0.9 to 20.8%; P = 0.034). In those patients who developed acute kidney injury after cardiac surgery, 2 of 38 subjects in the remote ischemic preconditioning group (5.3%) and 13 of 56 subjects in the control group (23.2%) failed to recover renal function at 90 days (absolute risk reduction, 17.9%; 95% CI, 4.8 to 31.1%; P = 0.020). Acute kidney injury biomarkers were also increased in patients reaching the major adverse kidney event endpoint compared to patients who did not.
  
  
  CONCLUSIONS
  Remote ischemic preconditioning significantly reduced the 3-month incidence of a composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction in high-risk patients undergoing cardiac surgery. Furthermore, remote ischemic preconditioning enhanced renal recovery in patients with acute kidney injury.
authors.affiliation: From the Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine (A.Z., H.V.A., C.S., M.K., M.M.) and Department of Cardiac Surgery (S.M.), University Hospital Münster, Münster, Germany; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (J.A.K.); Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany (P.R.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (D.G.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Zarbock
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmidt
authors.forename: Mira
authors.initials: M
authors.lastname: Küllmar
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenberger
authors.forename: Sven
authors.initials: S
authors.lastname: Martens
authors.forename: Dennis
authors.initials: D
authors.lastname: Görlich
authors.forename: Melanie
authors.initials: M
authors.lastname: Meersch
mesh_terms: D058186:Acute Kidney Injury / Q000517:prevention & control*; D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012306:Risk; D013995:Time; D016896:Treatment Outcome