Document Detail

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.
MedLine Citation:
PMID:  20974511     Owner:  NLM     Status:  MEDLINE    
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.
Vinod Venugopal; Chris M Laing; Andrew Ludman; Derek M Yellon; Derek Hausenloy
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-10-25
Journal Detail:
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:
Created Date:  2010-11-24     Completed Date:  2010-12-16     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1043-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Acute Kidney Injury / epidemiology,  physiopathology,  prevention & control*
Cardiac Surgical Procedures / adverse effects*
Coronary Artery Bypass / adverse effects*
Forearm / blood supply
Ischemia / physiopathology
Ischemic Preconditioning / methods*
Middle Aged
Outcome Assessment (Health Care)
Retrospective Studies
Risk Factors
Treatment Outcome
Grant Support
RG/08/015/26411//British Heart Foundation; //British Heart Foundation
Comment In:
Am J Kidney Dis. 2010 Dec;56(6):1019-22   [PMID:  21094912 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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