Age and Surgical Complexity impact on Renoprotection by Remote Ischemic Preconditioning during Adult Cardiac Surgery: A Meta analysis

Abstract

We aimed to conduct an up-to-date meta-analysis to comprehensively assess the renoprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing adult cardiac surgery. 21 randomized controlled trials (RCTs) with a total of 6302 patients were selected and identified. Compared with controls, RIPC significantly reduced the incidence of acute kidney injury (AKI) [odds ratio (OR) = 0.79; P = 0.02; I2 = 38%], and in particular, AKI stage I (OR = 0.65; P = 0.01; I2 = 55%). RIPC significantly shortened mechanical ventilation (MV) duration [weighted mean difference (WMD) = −0.79 hours; P = 0.002; I2 = 53%), and reduced intensive care unit (ICU) stay (WMD = −0.23 days; P = 0.07; I2 = 96%). Univariate meta-regression analyses showed that the major sources of heterogeneity for AKI stage I were age (coefficient = 0.06; P = 0.01; adjusted R2 = 0.86) and proportion of complex surgery (coefficient = 0.02; P = 0.03; adjusted R2 = 0.81). Subsequent multivariate regression and subgroup analyses also confirmed these results. The present meta-analysis suggests that RIPC reduces the incidence of AKI in adults undergoing cardiac surgery and this benefit was more pronounced in younger patients undergoing non-complex cardiac surgery. RIPC may also shorten MV duration and ICU stay. Future RCTs tailored for those most likely to benefit from RIPC warrants further investigation.

Abundance and Multilocus Sequence Analysis of Vibrio Bacteria Associated with Diseased Elkhorn Coral (Acropora palmata) of the Florida Keys

“…Likewise, Vibrio spp. are commonly detected, but at low abundance, in the coral microbiome (28,45,56,57), and are proposed to play a role in sulfur and nitrogen cycling in the coral holobiont (58)(59)(60)(61)(62). Strains of Vibrio alginolyticus, V. harveyi, V. campbellii, and V. parahaemolyticus have been isolated from coral mucus that are capable of fixing N 2 , and in doing so may function as coral mutualists under nonstressful conditions (58,63).…”

The clinical utility of remote ischemic preconditioning in protecting against cardiac surgery-associated acute kidney injury: A pilot randomized clinical trial

“…This is consistent with a similar meta-analysis where postoperative incidence of AKI was significantly reduced by RIPC (p = 0.02), but no benefit was found in terms of renal replacement therapy and mortality. 33 A recent meta-analysis including 27 randomized trials also showed that RIPC lowers the risk not only of acute renal failure, but also myocardial infarction, stroke and composite risk of allcause mortality; however, statistically the results were only marginally significant. 34 The recently published results of the 90-day follow-up of the RenalRIP trial showed that RIPC improves short-as well as long-term outcomes of high-risk patients undergoing cardiac surgery.…”

Remote Ischaemic Preconditioning Reduces Kidney Injury Biomarkers in Patients Undergoing Open Surgical Lower Limb Revascularisation: A Randomised Trial

“…For achieving ischaemia, pressure in the blood pressure cuff was raised for 5 minutes to 200 mmHg or, when the patient's blood pressure exceeded 180 mmHg, to a value that was 20 mmHg higher than the value of systolic blood pressure. In the sham group, pressure in the cuff was equal to venous pressure (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Between all episodes, there was a 5-minute period of reperfusion.…”

“…Although early studies have shown a renoprotective effect of RIPC in patients undergoing vascular surgery [7,8], the last 3 large studies report no benefit [9][10][11]. Still, recent meta-analyses have indicated a renoprotective effect of RIPC in patients undergoing cardiac surgery [12,13].…”