Remote ischemic conditioning for the prevention of contrast-induced acute kidney injury in patients undergoing intravascular contrast administration: a meta-analysis and trial sequential analysis of 16 randomized controlled trials

Zhou, Changcheng; Yao, Wen-Tao; Ge, Yu‐Zheng; Xu, Luwei; Wu, Rongqian; Gao, Xiaofei; Song, Kaiwei; Jiang, Xiaoyu; Wang, Min; Huang, Wenjuan; Zhu, Yunpeng; Li, Liang-Peng; Zhou, Lin; Xu, Zhongle; Zhang, Shengli; Zhu, Jun; Li, Wencheng; Jia, Ru

doi:10.18632/oncotarget.18106

Cited by 19 publications

(25 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another novelty of our work was that RIC was observed to reduce the short‐term incidence of MACEs, but this protection was lost during long‐term follow‐up. In accordance with Zhou et al (), RIC was found to reduce the CIN rate without aggravating the incidence of adverse events, but the significance was diminished after 6 months of follow‐up. This finding may be due to the inclusion of longer‐term follow‐up studies, which comprised patients with a history of CKD (Er et al, ; Zhou et al, ), and the elevated severity of postoperative blood flow thrombolysis in MI patients (Crimi et al, ).…”

Section: Discussionsupporting

confidence: 87%

“…We separated 18 studies into three groups according to the dose of CM administered: ≤100 ml group (low) 1 (Cao et al, ; Ferdinandy et al, ; Gholoobi et al, ; Igarashi et al, ), 100–200 ml group (medium) 1 (Balbir Singh et al, ; Bøtker et al, ; Er et al, ; Ferdinandy et al, ; Giricz et al, ; Han et al, ; Hausenloy et al, ; Hausenloy & Yellon, ; Hoole et al, ; Luo et al, ; Moretti et al, ; Narula et al, ; Sadat et al, ; Savaj et al, ; White et al, ; Xu et al, ; Yamanaka et al, ; Zagidullin et al, ; Zhou et al, , ), and >200 ml group (high) 2 (Deftereos et al, ; Sadat et al, ). RIC significantly decreased the incidence of CIN in all three groups (low group: OR = 0.29, 95% CI 0.14, 0.60, p < .05; medium group: OR = 0.47, 95% CI 0.34, 0.64; p < .05; and high group: OR = 0.47, 95% CI 0.26, 0.56; p < .05; Table ).…”

Section: Resultsmentioning

confidence: 99%

“…After the discovery of RIC induced by transient limb ischemia, this procedure became an attractive renoprotective method that has been further elucidated by several experimental studies and clinical trials. The meta‐analyses conducted by Bei et al () and Zhou et al () both indicated that RIC had a protective effect against CIN and reduced the incidence of relevant adverse events. However, those two meta‐analyses included participants who had undergone different interventions for their conditions, such as cardiac and vascular surgery, and new trials including patients with ST‐elevation myocardial infarction had been published since those meta‐analyses were conducted; thus, a new meta‐analysis is needed.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The efficacy of remote ischemic conditioning in preventing contrast‐induced nephropathy among patients undergoing coronary angiography or intervention: An updated systematic review and meta‐analysis

Zhan

Zhu

et al. 2019

Noninvasive Electrocardiol

View full text Add to dashboard Cite

Background Numerous trials have investigated the effect of remote ischemic conditioning (RIC) in preventing contrast‐induced nephropathy (CIN) in patients receiving contrast medium (CM). This meta analysis aims to validate the role of RIC in preventing CIN. Methods We searched the PubMed, EMBASE, and Web of Science databases for eligible randomized controlled trials (RCTs) published before April 27, 2019. Two investigators independently extracted basic characteristics from each study. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to examine the treatment effect. Results A total of 18 studies comprising 2,503 patients were included in our meta‐analysis. Compared with conventional therapy, RIC significantly reduced the risk of CIN (OR = 0.43, 95% CI: 0.33, 0.56, p < .05). Subgroup analyses showed that the protective effect of RIC was stronger in the low‐osmolar contrast media group (OR = 0.32; 95% CI: 0.23, 0.45, p < .05) and the nondiabetic group (OR = 0.39; 95% CI: 0.29, 0.53 p < .05). RIC also significantly reduced major adverse cardiovascular events within the first 6 months (OR = 0.39; p < .05), but the influence was not present after long‐term follow‐up. Conclusions Our meta‐analysis showed that RIC could effectively reduce CIN risk and decrease the short‐term incidence of relevant adverse events. Furthermore, the effects of CIN are more pronounced in nondiabetic patients and with the use of low‐osmolar contrast medium. This meta‐analysis of small trials suggests a possible protective effect of RIC on contrast‐induced nephropathy and favors the performance of a large randomized trial to further investigate this strategy.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The efficacy of remote ischemic conditioning in preventing contrast‐induced nephropathy among patients undergoing coronary angiography or intervention: An updated systematic review and meta‐analysis

Zhan

Zhu

et al. 2019

Noninvasive Electrocardiol

View full text Add to dashboard Cite

show abstract

“…Contrast medium with lower osmolality, hydration protocols, and prophylactic drugs such as statins and ascorbic acid are among the common methods used to prevent this complication (7). Given the weaknesses and the difficulty of these protective methods and the considerable incidence of CIN-AKI despite their usage, a safe, achievable and effective strategy is needed to block this complication (8).…”

Section: Original Articlementioning

confidence: 99%

Is there a protective effect with remote ischemic preconditioning on contrast-induced acute renal injury after coronary angiography in low-risk patients?

et al. 2018

View full text Add to dashboard Cite

Introduction: Contrast-induced acute kidney injury (CIN-AKI) is a serious complication of coronary angiography. Given the weaknesses in the common protective methods used to prevent CIN-AKI, a safe and effective strategy is needed. RIPC has been shown to have a nephroprotective effect. Objectives: We aimed to determine the protective effect of RIPC on CIN-AKI after angiography or percutaneous coronary intervention (PCI) in low-risk patients. Patients and Methods: In our study, 140 low-risk patients who needed angiography or PCI, were assigned to either RIPC or control group. In each group, serum creatinine and urinary neutrophil gelatinaseassociated lipocalin (uNGAL) were measured before the procedure. Serum creatinine was measured daily for 2 days and uNGAL was measured 6 and 24 hours after the procedure. Diagnosis of AKI was, according to the Kidney Disease; Improving Global Outcomes (KDIGO) criteria (2012). Results: The mean age in the remote ischemic preconditioning (RIPC) group was 56.8 ± 11.4 years and 56.3 ± 11.8 years in the control group. We observed no significant difference regarding patient’s characteristic and renal biomarkers at baseline. There was no significant difference in the incidence of AKI (P = 0.116). The uNGAL increased by 36.2% 6-hour after the procedure in patients with AKI, while at the same time, this biomarker increased only by 4.3% in patients without AKI. Conclusion: We concluded that RIPC, with 3 cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease CIN-AKI or altering renal biomarkers course in low-risk patients undergoing coronary angiography or PCI. Additionally, uNGAL, seems to be an appropriate biomarker for early diagnosis of CIN-AKI, 6 hours after contrast media exposure.

show abstract

“…Indeed, growing number of clinical reports have shown the beneficial effects of LIPC against CI-AKI [9][10][11]. A recent meta-analysis concluded demonstrated that LIPC could effectively exert reno-protective role and significantly decrease the incidence of CI-AKI [12].…”

mentioning

confidence: 99%

Limb ischemic preconditioning ameliorates renal microcirculation through activation of PI3K/Akt/eNOS signaling pathway after acute kidney injury

et al. 2020

View full text Add to dashboard Cite

Purpose: Contrast-induced acute kidney injury (CI-AKI) resulting from administration of iodinated contrast media (CM) is the third leading cause of hospital-acquired acute kidney injury and is associated with substantial morbidity and mortality. Deteriorated renal microcirculation plays an important role in CI-AKI. Limb ischemic preconditioning (LIPC), where brief and non-injurious ischemia/reperfusion is applied to a limb prior to the administration of the contrast agent, is emerging as a promising strategy for CI-AKI prevention. However, it is not known whether the renal protection of LIPC against CI-AKI is mediated by regulation of renal microcirculation and the molecular mechanisms remain largely unknown. Methods: In this study, we examined the renal cortical and medullary blood flow in a stable CI-AKI model using 5/6-nephrectomized (NE) rat. The LIPC and sham procedures were performed prior to the injection of CM. Furthermore, we analyzed renal medulla hypoxia using in vivo labeling of hypoxyprobe. Pharmacological inhibitions and western blotting were used to determine the underlying molecular mechanisms. Results: In this study, we found LIPC significantly ameliorated CM-induced reduction of medullary blood flow and attenuated CM-induced hypoxia. PI3K inhibitor (wortmannin) treatment blocked the regulation of medullary blood flow and the attenuation of hypoxia of LIPC. Phosphorylation of Akt/eNOS was significantly decreased via wortmannin treatment compared with LIPC. Nitric oxide synthase-inhibitor [Nω-nitro-l-arginine methyl ester (L-NAME)] treatment abolished the above effects and decreased phosphorylation of eNOS, but not Akt. Conclusions: Collectively, the results demonstrate that LIPC ameliorates CM-induced renal vasocontraction and is mediated by activation of PI3K/Akt/eNOS signaling pathway.

show abstract

Remote ischemic conditioning for the prevention of contrast-induced acute kidney injury in patients undergoing intravascular contrast administration: a meta-analysis and trial sequential analysis of 16 randomized controlled trials

Cited by 19 publications

References 61 publications

The efficacy of remote ischemic conditioning in preventing contrast‐induced nephropathy among patients undergoing coronary angiography or intervention: An updated systematic review and meta‐analysis

The efficacy of remote ischemic conditioning in preventing contrast‐induced nephropathy among patients undergoing coronary angiography or intervention: An updated systematic review and meta‐analysis

Is there a protective effect with remote ischemic preconditioning on contrast-induced acute renal injury after coronary angiography in low-risk patients?

Limb ischemic preconditioning ameliorates renal microcirculation through activation of PI3K/Akt/eNOS signaling pathway after acute kidney injury

Contact Info

Product

Resources

About