Remote ischaemic conditioning-therapeutic opportunities in renal medicine

Following ischaemic insult, tissue damage is extended after reperfusion, known as an ischaemia reperfusion injury. Ischaemic conditioning-the application of transient, non-lethal, episodes of ischaemia-reduces the effect of a larger ischaemic insult, and limits the reperfusion injury. How this phenomenon might be exploited as a therapeutic treatment is now the subject of a number of clinical trials. From initial trials focusing on the mitigation of cardiac injury, interest has expanded to examine the potential for its use as an adjunctive therapy in different clinical scenarios, including renal medicine. In this Review, we discuss different forms of conditioning, potential molecular mechanisms underpinning its effect, and potential applications in the setting of acute kidney injury, chronic kidney disease and end-stage renal disease.