90 days impacts of remote ischemic preconditioning on patients undergoing open total aortic arch replacement: a post-hoc analysis of previous trial

Abstract

Background: In the previous randomized controlled trial by our research group, we evaluated the effect of remote ischemic preconditioning (RIPC) in 130 patients (65 per arm) on acute kidney injury (AKI) within 7 days of open total aortic arch replacement. Significantly fewer RIPC-treated patients than sham-treated patients developed postoperative AKI, and, epically, RIPC significantly reduced serious AKI (stage II-III). However, the long-term effect of RIPC in patients undergoing open total aortic arch replacement is unclear. Methods: This study was a post-hoc analysis. We aimed to assess the roles of RIPC in major adverse kidney events (MAKE), defined as consisting persistent renal dysfunction, renal replacement therapy and mortality, within 90 days after surgery in patients receiving open total aortic arch replacement. Results: In this 90-day follow-up study, data were available for all study participants. We found that RIPC failed to improve the presence of MAKE within 90 days after surgery (RIPC: 7 of 65[10.8%]) vs sham: 15 of 65[23.1%]; P = 0.061). In those patients who developed AKI after surgery, we found that the rate of MAKE within 90 days after surgery differed between the RIPC group and the sham group (RIPC: 4 of 36[11.2%]; sham: 14 of 48[29.2%]; P = 0.046). Conclusions: At 90 days after open total aortic arch replacement, we failed to find a difference between the renoprotective effects of RIPC and sham treatment. The effectiveness or ineffectiveness of RIPC should be further investigated in a large randomized sham-controlled trial. Trial registration: This study was approved by the Ethics Committee of Fuwai Hospital (No. 2016-835) and our previous study was registered at clinicaltrials.gov before patient enrollment (NCT03141385; principal investigator: G.W.; date of registration: March 5, 2017).

Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery

“…Among them, the ‘any-stage AKI risk score’ has shown a good performance for all stages of AKI and is also available in clinical practice as a web-based calculator [ 10 ]. Nevertheless, the inclusion of novel risk factors of AKI in a risk prognostic model has been widely prompted, also on the basis of the results of several clinical trials that have failed in demonstrating the efficacy of prevention strategies, such as the use of statins at high-doses or the remote ischemic preconditioning (RIPC) treatment [ 4 , 11 , 12 ]. We designed a retrospective, observational, study enrolling patients who underwent CS to evaluate both the predictors of the onset of AKI and the role of cardiorenal markers on individual prognosis (i.e.…”