Nephroprotective effects of remote ischemic preconditioning in coronary angiography

Abstract

RIPC proved nephroprotective effect in prevention of contrast-induced nephropathy in CHD subjects with mild to moderate lowered eGFR.

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

“…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 ).…”

“…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 ). Furthermore, we compared low‐osmolar and iso‐osmolar contrast agents focusing on renal safety and found that RIC decreased the rate of CIN in the low‐osmolar contrast group (Cao et al, ; Deftereos et al, ; Er et al, ; Hoole et al, ; Igarashi et al, ; Luo et al, ; Menting et al, ; Moretti et al, ; Yamanaka et al, ; Zagidullin et al, ) (OR = 0.32; 95% CI 0.23, 0.45; p < .05); however, RIC was not effective in either the iso‐osmolar contrast agent groups (Balbir Singh et al, ; Gholoobi et al, ) (OR = 0.75; 95% CI 0.31, 1.83; p = .52) or groups for which the contrast media type was not mentioned (OR = 0.66; 95% CI 0.41, 1.06; p = .09; Table ).…”

“…Although the mechanism of CIN in patients exposed to contrast medium has yet to be elucidated, renal ischemic injury and direct tubule toxicity in renal tubular cells have already been proposed (Igarashi et al, ; Zagidullin et al, ; Zhou et al, ). Another possible mechanism of injury is that CM elicits hypoxia of the renal medulla and leads to free radical production via postischemic oxidative stress in the renal tissue (Er et al, ; Savaj et al, ).…”

“…Based on the inclusion and exclusion criteria, 18 relevant studies were included. The study selection process is shown in Figure 1 (Balbir Singh et al, 2016;Cao, Wang, Zhang, Xia, & Yang, 2018;Crimi et al, 2013;Deftereos et al, 2013;Elbadawi et al, 2017;Er et al, 2012;Gholoobi, Sajjadi, Shabestari, Eshraghi, & Shamloo, 2015;Hoole et al, 2009;Igarashi, Iino, Watanabe, & Ito, 2013;Lavi et al, 2014;Luo et al, 2013;Menting et al, 2015;Moretti et al, 2018;Savaj, Savoj, Jebraili, & Sezavar, 2014;Xu et al, 2015;Yamanaka et al, 2015;Zagidullin et al, 2017;Zhou et al, 2018).…”

“…Our meta-analysis included 2,503 patients from 18 studies, of which 1,243 patients receiving RIC before or after surgery were assigned to the experimental group, and the remaining 1,260 patients were assigned to the control group. Two trials defined CIN as a relative increase of >25% from baseline (Crimi et al, 2013;Hoole et al, 2009); two trials used the definition of either an absolute increase in Scr > 0.5 mg/dl or 44.2 mmol/L or a relative increase of >25% from baseline within 16 hr after CM exposure (Luo et al, 2013;Xu et al, 2015), one trial used the same criteria as above within 24 hr after exposure (Lavi et al, 2014), three trials within 48 hr after exposure (Balbir Singh et al, 2016;Moretti et al, 2018;Zagidullin et al, 2017), three trials between 48 and 72 hr after exposure (Menting et al, 2015;Yamanaka et al, 2015;Zhou et al, 2018), one trial within 72 hr after exposure (Cao et al, 2018), and three trials within 96 hr after exposure (Deftereos et al, 2013;Elbadawi et al, 2017;Zagidullin et al, 2017); and two trials used the definition of an absolute increase in Scr of 0.3 mg/dl within 24 or 48 hr of exposure to the contrast agent (Gholoobi et al, 2015;Savaj et al, 2014). The mean CM dose ranged from 77.7 to 270 ml.…”