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Remote Ischemic Preconditioning To Reduce Contrast-Induced Nephropathy: A Randomized Controlled Trial.

T P Menting1, T B Sterenborg1, Y de Waal2

  • 1Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|May 28, 2015
PubMed
Summary
This summary is machine-generated.

Remote ischemic preconditioning (RIPC) did not prevent contrast induced nephropathy (CIN) in at-risk patients. However, RIPC showed potential benefits for those with a high risk score (Mehran score ≥11).

Keywords:
Acute kidney injury – pre- and post-hydrationContrast induced nephropathyRandomized controlled trialRemote ischemic preconditioning

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Area of Science:

  • Nephrology
  • Cardiology
  • Intensive Care Medicine

Background:

  • Contrast-induced nephropathy (CIN) remains a significant concern despite current preventive strategies.
  • Contrast media can induce renal medulla ischemia-reperfusion injury.
  • Remote ischemic preconditioning (RIPC) is a safe, non-invasive method to mitigate ischemia-reperfusion injury.

Purpose of the Study:

  • To evaluate the efficacy of RIPC as an adjunct to standard preventive measures for CIN.
  • To determine if RIPC reduces the incidence or severity of contrast-induced acute kidney injury in at-risk patients.

Main Methods:

  • A multicenter, single-blinded, randomized controlled trial (RIPCIN study) involving 76 at-risk patients.
  • Intervention group received standard hydration plus RIPC (4 cycles of 5-min ischemia/5-min reperfusion).
  • Control group received standard hydration with sham preconditioning.
  • Primary outcome: change in serum creatinine from baseline to 48-72 hours post-contrast.

Main Results:

  • No significant difference in serum creatinine change was observed between RIPC and sham groups for the overall study population.
  • CIN occurred in 4 patients (2 in each group).
  • Subgroup analysis of patients with a Mehran risk score ≥11 revealed a significantly reduced serum creatinine increase in the RIPC group compared to the sham group.

Conclusions:

  • RIPC, when added to standard care, did not significantly improve serum creatinine levels in patients at risk of CIN based on Dutch guidelines.
  • RIPC may offer a protective benefit for patients identified as having a high or very high risk of CIN (Mehran score ≥11).