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Remote Ischemic Preconditioning for Prevention of Contrast-Associated Acute Kidney Injury following Coronary
Indu Ramachandra Rao1, Ganesh Paramasivam2, Shravana Acharya1
1Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Insights
Remote ischemic preconditioning significantly reduces contrast-associated acute kidney injury (AKI) and in-hospital major adverse cardiovascular events (MACE) in patients undergoing coronary procedures. This simple preventive strategy is supported for clinical practice.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-associated acute kidney injury (AKI) is a risk for patients undergoing coronary angiography or percutaneous coronary intervention (PCI).
- Remote ischemic preconditioning (RIPC) has shown potential for preventing contrast-associated AKI and offering cardioprotection, but evidence is inconsistent.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating RIPC's efficacy in reducing contrast-associated AKI.
- To assess RIPC's impact on short-term kidney and cardiac outcomes in patients undergoing coronary angiography or PCI.
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, Embase, Cochrane).
- Thirty-six RCTs involving 10,923 patients were included, comparing RIPC to sham RIPC or usual care.
- Outcomes included contrast-associated AKI, dialysis, mortality, and major adverse cardiovascular and kidney events (MACE, MAKE30), with data pooled using random-effects models.
Main Results:
- RIPC significantly reduced contrast-associated AKI (RR 0.54; high-certainty evidence).
- RIPC likely reduced in-hospital MACE (RR 0.51; moderate-certainty evidence).
- No significant differences were observed for dialysis, in-hospital mortality, or 30-day outcomes.
Conclusions:
- Remote ischemic preconditioning is effective in lowering the risk of contrast-associated AKI.
- RIPC also demonstrates a probable benefit in reducing in-hospital MACE.
- The findings support RIPC as a valuable adjunctive preventive strategy in clinical practice for patients undergoing coronary procedures.
Key Points:
Remote ischemic preconditioning reduced the risk of contrast-associated AKI in patients undergoing coronary angiography or percutaneous coronary intervention. The benefits of remote ischemic preconditioning were consistent across coronary angiography, percutaneous coronary intervention, diabetes, and CKD subgroups. Remote ischemic preconditioning probably reduced in-hospital major adverse cardiovascular events, although there was no significant impact on 30-day kidney and cardiac outcomes.
Background:
Remote ischemic preconditioning may prevent contrast-associated AKI and have cardioprotective effects in patients undergoing coronary angiographic procedures; however, results have been inconsistent. The aim of this systematic review and meta-analysis was to evaluate whether remote ischemic preconditioning lowers the risk of contrast-associated AKI and improves short-term kidney and cardiac outcomes in patients undergoing coronary angiography or percutaneous coronary intervention (PCI).
Methods:
We performed a comprehensive literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception through December 6, 2025. Randomized controlled trials (RCTs) comparing remote ischemic preconditioning with either sham remote ischemic preconditioning or usual care for kidney and/or cardiac outcomes in patients undergoing coronary angiography or PCI were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Outcomes studied were contrast-associated AKI, need for dialysis, in-hospital mortality, in-hospital major adverse cardiovascular events (MACE), 30-day mortality, 30-day MACE, and major adverse kidney events at 30 days. Data were pooled using a random-effects model and expressed as risk ratios (RR) with 95% confidence intervals (CI). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Results:
Of the 5532 records identified, 36 RCTs encompassing 10,923 patients were included in this systematic review. Compared with sham remote ischemic preconditioning or usual care, remote ischemic preconditioning significantly reduced contrast-associated AKI (RR, 0.54; 95% CI, 0.45 to 0.65; 30 RCTs, 5078 participants; high-certainty evidence). Remote ischemic preconditioning probably reduced in-hospital MACE (RR, 0.51; 95% CI, 0.26 to 0.98; four RCTs, 1266 participants; moderate-certainty evidence). There were no differences in the need for dialysis, in-hospital mortality, 30-day mortality, and 30-day MACE.
Conclusions:
Remote ischemic preconditioning reduced the risk of contrast-associated AKI and in-hospital MACE in patients undergoing coronary angiography or PCI.
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