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Related Concept Videos

Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

469
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
469

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Related Experiment Video

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Use of a Hanging-weight System for Isolated Renal Artery Occlusion
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Remote ischemic conditioning for kidney protection: A meta-analysis.

Ling Zhang1, Yongshu Diao2, Guangjun Chen3

  • 1Department of Nephrology, West China Hospital of Sichuan University, Sichuan, Chengdu, China; Department of Intensive Care Unit, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia.

Journal of Critical Care
|March 4, 2016
PubMed
Summary

Remote ischemic conditioning (RIC) may reduce investigator-defined acute kidney injury (AKI), but the effect is small and not robust across standardized criteria. Evidence does not support widespread RIC application due to inconsistent patient-centered outcomes.

Keywords:
Acute kidney injuryKidneyMeta-analysisRemote ischemic preconditioningRenal replacement therapy

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Area of Science:

  • Nephrology
  • Cardiology
  • Critical Care Medicine

Background:

  • Inconsistent results from randomized controlled trials (RCTs) exist regarding the kidney protective effects of remote ischemic conditioning (RIC).
  • Investigating the efficacy of RIC in preventing kidney injury is crucial given its potential clinical applications.

Purpose of the Study:

  • To systematically review and meta-analyze RCTs evaluating the impact of RIC on kidney outcomes.
  • To assess the consistency of RIC's effects across different definitions of acute kidney injury (AKI) and patient populations.

Main Methods:

  • A comprehensive search of multiple databases (Medline, Embase, Cochrane Library, Google Scholar, SinoMed) was conducted up to November 2015.
  • Included 37 RCTs involving 8168 patients, performing pooled analyses and subgroup analyses.
  • Evaluated kidney events, including investigator-defined AKI, RIFLE, AKIN, KDIGO criteria, renal replacement therapy, estimated glomerular filtration rate, and serum creatinine.

Main Results:

  • Pooled analysis of all RCTs indicated RIC significantly reduced investigator-defined AKI (RR 0.84, 95% CI 0.73-0.96).
  • This significant effect was not observed when using standardized AKI criteria (RIFLE, AKIN, KDIGO) (RR 0.87, 95% CI 0.74-1.02).
  • RIC demonstrated a benefit in preventing AKI after percutaneous coronary intervention but not after cardiac surgery; no significant differences were found for renal replacement therapy, eGFR, or serum creatinine.

Conclusions:

  • Remote ischemic conditioning may offer a small benefit in preventing investigator-defined AKI.
  • The evidence supporting RIC's efficacy is not robust due to inconsistent results across standardized AKI definitions and lack of impact on key renal function markers.
  • Recent large-scale RCTs focusing on patient-centered outcomes do not support the broad application of RIC.