Effect of remote ischemic preconditioning on kidney injury among high-risk patients undergoing cardiac surgery: a randomized clinical trial
- Alexander Zarbock 1, Christoph Schmidt 1, Hugo Van Aken 1, Carola Wempe 1, Sven Martens 2, Peter K Zahn 3, Britta Wolf 3, Ulrich Goebel 4, Christian I Schwer 4, Peter Rosenberger 5, Helene Haeberle 5, Dennis Görlich 6, John A Kellum 7, Melanie Meersch 1,
- 1Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany.
- 2Department of Cardiac Surgery, University of Münster, Münster, Germany.
- 3Department of Anaesthesiology, Intensive Care Medicine, Palliative and Pain Medicine, University Hospital Bochum, Bochum, Germany.
- 4Department of Anaesthesiology and Intensive Care Medicine, University Hospital Freiburg, Freiburg, Germany.
- 5Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany.
- 6Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
- 7Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
- 0Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany.
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View abstract on PubMed
Summary
This summary is machine-generated.Remote ischemic preconditioning significantly reduced acute kidney injury and renal replacement therapy use in high-risk cardiac surgery patients. This non-invasive method shows promise for improving patient outcomes and warrants further investigation.
Area Of Science
- Nephrology and Cardiovascular Surgery
- Perioperative Medicine
- Critical Care
Background
- Acute kidney injury (AKI) is a significant risk following cardiac surgery.
- No effective interventions are currently established to mitigate AKI risk in this setting.
- Identifying protective strategies is crucial for improving patient outcomes.
Purpose Of The Study
- To evaluate the efficacy of remote ischemic preconditioning (RIPC) in reducing the incidence and severity of AKI.
- To assess the impact of RIPC on renal replacement therapy (RRT) and other clinical outcomes.
- To investigate the effect of RIPC on specific AKI biomarkers.
Main Methods
- A multicenter randomized controlled trial involving 240 high-risk patients undergoing cardiac surgery.
- Patients were assigned to either RIPC (brief ischemia/reperfusion cycles) or sham RIPC (control).
- Primary endpoint was AKI incidence within 72 hours post-surgery, defined by KDIGO criteria.
Main Results
- RIPC significantly decreased AKI rates (37.5% vs 52.5%) and reduced the need for RRT (5.8% vs 15.8%).
- Intensive care unit stay was shorter in the RIPC group (3 vs 4 days).
- RIPC attenuated the release of urinary biomarkers (NGAL and KIM-1), with no significant impact on MI, stroke, or mortality.
Conclusions
- Remote ischemic preconditioning is an effective intervention for reducing AKI and RRT use in high-risk cardiac surgery patients.
- The observed benefits suggest RIPC as a potential protective strategy.
- Further research is warranted to confirm these findings and explore broader clinical applications.
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