Prevention of contrast induced nephropathy by ischemic preconditioning in patients undergoing percutaneous coronary angiography

Abstract

BackgroundContrast-induced nephropathy (CIN) is the acute deterioration of renal function after parenteral administration of radio contrast media in the absence of other causes. The true incidence of CIN varies because of differences among the published studies in the definition of CIN, the proportion of high-risk patients, the types of contrast media, and the use of preventive measures. Remote ischemic preconditioning (IPC) may offer a non-pharmacological prevention strategy for lowering CIN in patients undergoing coronary procedures. The assumption that IPC produces protective effects on tissues or organs by multiple brief cycles of ischemia and reperfusion applied to another remote tissue or organ.AimTo investigate the effect of ischemic preconditioning in prevention of CIN in patients with renal impairment undergoing percutaneous coronary angiography.ResultsIn this study, 100 patients undergoing elective PCI with a base line creatinine clearance <60 ml/min were studied. Patients were divided into two equal groups (ischemic preconditioning group and control group). The incidence of CIN was markedly lower in ischemic preconditioning group 14% VS 38% in control group. The incidence of CIN difference as was found to be (24%). Amount of dye used, decreased LVEF and presence of a significant LAD lesion were significant risk factors for occurrence of CIN.ConclusionsThe current study showed that remote ischemic preconditioning plays an important role in prevention of CIN in patients undergoing PCI with renal impairment GFR < 60 ml/min. The amount of contrast, decreased LVEF, and presence of LAD significant lesion were significant risk factors for developing of CIN and these subgroups benefited from application of ischemic preconditioning.

Remote ischemic preconditioning for prevention of contrast-induced acute kidney injury in patients of CKD stage III and IV undergoing elective coronary angiography: A randomized controlled trial

“…Results similar to our study have been reported in several trials[ 40 41 ] including the EUROCRIPS Cardiogroup 1 study[ 42 ]; in the latter, a benefit was found in the nondiabetic cohort but not in the diabetics. A meta-analysis of published trials suggested that rIPC can improve myocardial salvage index and myocardial infarct size post-MI.…”

Remote ischemic preconditioning reduces the incidence of contrast‐induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta‐analysis of randomized controlled trials

“…One hundred sixty-four were excluded after screening the title/abstracts. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] After assessing 17 full-text for eligibility, we excluded three because (a) not specific to preconditioning; (b) not specific to CAG/PCI, includes other diagnostic imaging, (c) there is an updated result for the trial. We included 14 studies in qualitative synthesis and meta-analysis.…”

“…There were 181 records after removal of duplicates. One hundred sixty‐four were excluded after screening the title/abstracts 8–21 . After assessing 17 full‐text for eligibility, we excluded three because (a) not specific to preconditioning; (b) not specific to CAG/PCI, includes other diagnostic imaging, (c) there is an updated result for the trial.…”

precise-dapt score as a predictor of contrast induced nephropathy in acute coronary syndrome patients undergoing per cutaneous coronary intervention

“…The decision whether to use a thrombus aspiration device before or during PCI was left to the operator's discretion. Primary PCI was performed according to standard guidelines [9] .…”

“…The Mehran CIN risk score included eight clinical and procedural variables: presence of hypotension, congestive heart failure, chronic kidney disease, diabetes, age >75 years, anemia, requirement of intra-aortic balloon pump, and the volume of contrast agent used. Patients were categorized into four risk groups based on MS: low (≤ 5), moderate (6)(7)(8)(9)(10), high (11)(12)(13)(14)(15), and very high (≥ 16). Risk groups were compared for all study variables.…”