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Randomized controlled trial of remote ischemic preconditioning in children having cardiac surgery
Yuk M Law1,2, Christine Hsu3, Sangeeta R Hingorani4,5
1Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA. Yuk.law@seattlechildrens.org.
Insights
Remote ischemic preconditioning (RIPC) may offer kidney protection for children undergoing cardiac surgery. Further studies are needed to confirm its effectiveness in high-risk pediatric populations.
Area of Science:
- Cardiology
- Nephrology
- Pediatric Surgery
Background:
- Children undergoing cardiac surgery face risks of acute kidney injury (AKI) and cardiac dysfunction.
- Remote ischemic preconditioning (RIPC) presents an opportunity to protect end-organ function during such procedures.
- This study investigated RIPC's potential to mitigate kidney and myocardial injury in pediatric cardiac surgery patients.
Purpose of the Study:
- To evaluate the efficacy of remote ischemic preconditioning (RIPC) in reducing kidney and myocardial injury in children undergoing cardiac surgery.
- To assess the impact of RIPC on biomarkers of kidney function and cardiac strain.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted.
- Participants were children undergoing cardiac surgery.
- Key endpoints included changes in creatinine, estimated glomerular filtration rate (eGFR), AKI incidence, B-type natriuretic peptide, and troponin I levels.
Main Results:
- While no significant differences were found in creatinine or eGFR, a trend for decreased cystatin C was observed in the RIPC group.
- The incidence of AKI was numerically lower in the RIPC group (36%) compared to the control group (54%), with adjusted odds ratios suggesting protection.
- No significant differences were observed in cardiac biomarkers or overall clinical outcomes between the groups.
Conclusions:
- Remote ischemic preconditioning (RIPC) shows a potential for kidney protection in pediatric cardiac surgery patients.
- Larger studies involving higher-risk populations are necessary to definitively establish RIPC's efficacy.
- The trial was registered on ClinicalTrials.gov (NCT01260259).
Background:
Children undergoing cardiac surgery are at risk for acute kidney injury (AKI) and cardiac dysfunction. Opportunity exists in protecting end organ function with remote ischemic preconditioning. We hypothesize this intervention lessens kidney and myocardial injury.
Methods:
We conducted a randomized, double blind, placebo controlled trial of remote ischemic preconditioning in children undergoing cardiac surgery. Pre-specified end points are change in creatinine, estimated glomerular filtration rate, development of AKI, B-type natriuretic peptide and troponin I at 6, 12, 24, 48, 72 h post separation from bypass.
Results:
There were 45 in the treatment and 39 patients in the control group, median age of 3.5 and 3.8 years, respectively. There were no differences between groups in creatinine, cystatin C, eGFR at each time point. There was a trend for a larger rate of decrease, especially for cystatin C (p = 0.042) in the treatment group but the magnitude was small. AKI was observed in 21 (54%) of control and 16 (36%) of treatment group (p = 0.094). Adjusting for baseline creatinine, the odds ratio for AKI in treatment versus control was 0.31 (p = 0.037); adjusting for clinical characteristics, the odds ratio was 0.34 (p = 0.056). There were no differences in natriuretic peptide or troponin levels between groups. All secondary end points of clinical outcomes were not different.
Conclusions:
There is suggestion of RIPC delivering some kidney protection in an at-risk pediatric population. Larger, higher risk population studies will be required to determine its efficacy. Trial registration and date: Clinicaltrials.gov NCT01260259; 2021.
