| Effect of remote ischemic preconditioning on acute kidney injury in nondiabetic patients undergoing coronary artery bypass graft surgery: a secondary analysis of 2 small randomized trials. | |
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MedLine Citation:
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PMID: 20974511 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Novel treatment strategies are required to reduce the development of acute kidney injury (AKI) in patients undergoing cardiac surgery. In this respect, remote ischemic preconditioning (RIPC), a phenomenon in which transient nonlethal ischemia applied to an organ or tissue protects another organ or tissue from subsequent lethal ischemic injury, is a potential renoprotective strategy. STUDY DESIGN: Secondary analysis of 2 randomized trials. SETTING & PARTICIPANTS: 78 consenting selected nondiabetic patients in a university teaching hospital undergoing elective coronary artery bypass graft (CABG) surgery recruited to 2 previously reported randomized studies. INTERVENTION: RIPC consisted of three 5-minute cycles of right forearm ischemia, induced by inflating a blood pressure cuff on the upper arm to 200 mm Hg, with an intervening 5 minutes of reperfusion, during which time the cuff was deflated. The control consisted of placing an uninflated cuff on the arm for 30 minutes. OUTCOMES: AKI measured using Acute Kidney Injury Network (AKIN) criteria, duration of hospital stay, in-hospital and 30-day mortality. RESULTS: Numbers of participants with AKI stages 1, 2, and 3 were 1 (3%), 3 (8%), and 0 in the intervention group compared with 10 (25%), 0, and 0 in the control group, respectively (P = 0.005). The decrease in AKI was independent of the effect of concomitant aortic valve replacement and cross-clamp times, which were distributed unevenly between the 2 groups. LIMITATIONS: Retrospective analysis of data. More patients in the RIPC group underwent concomitant aortic valve replacement with CABG; although we have corrected statistically for this imbalance, it remains an important confounding variable. CONCLUSIONS: RIPC induced using transient forearm ischemia decreased the incidence of AKI in nondiabetic patients undergoing elective CABG surgery in this retrospective analysis. A large prospective clinical trial is required to study this effect and clinical outcomes in patients undergoing cardiac surgery. |
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Authors:
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Vinod Venugopal; Chris M Laing; Andrew Ludman; Derek M Yellon; Derek Hausenloy |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2010-10-25 |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 56 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-24 Completed Date: 2010-12-16 Revised Date: 2013-04-12 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 1043-9 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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The Hatter Cardiovascular Institute, University College London Hospital, London, UK. v.venugopal@ucl.ac.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Kidney Injury
/
epidemiology,
physiopathology,
prevention & control* Aged Cardiac Surgical Procedures / adverse effects* Coronary Artery Bypass / adverse effects* Female Forearm / blood supply Humans Incidence Ischemia / physiopathology Ischemic Preconditioning / methods* Male Middle Aged Outcome Assessment (Health Care) Retrospective Studies Risk Factors Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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//British Heart Foundation |
| Comments/Corrections | |
Comment In:
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Am J Kidney Dis. 2010 Dec;56(6):1019-22
[PMID:
21094912
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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