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

Abstract

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a serious complication of coronary angiography (CA). The aim of this randomized, parallel group, single blind, sham-controlled trial was to assess the safety and efficacy of the remote ischemic preconditioning on the prevention of CI-AKI. Methods: Patients of 18–80 years of age with CKD 3 and 4, who were admitted for elective coronary angiography in a tertiary care hospital in eastern India were randomized in a 1:1 ratio to standard care with ischemic preconditioning ( n = 45; intermittent arm ischemia through 4 cycles of 5-min inflation and 5-min deflation of a blood pressure cuff) or with standard care and sham ischemic preconditioning ( n = 42). Overall, both study groups were at moderate risk of developing CI-AKI according to the Mehran risk score. The primary endpoint was the incidence of CI-AKI, defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dL above baseline at 48 h after contrast medium exposure. Results: CI-AKI occurred in 8 patients (19.04%) in the control group and 2 (4.4%) in the remote ischemic preconditioning group (odds ratio, 0.198, 95% confidence interval, 0.087 to 0.452; P = 0.04). No major adverse events were related to remote ischemic preconditioning. Conclusions: This study indicates that remote ischemic preconditioning is a simple and well-tolerated procedure, which reduces the incidence of CI-AKI in CKD 3 and 4 patients undergoing coronary angiography.

An Overview of Contrast-induced Acute Kidney Injury

“…The prevalence of CI-AKI in India has been summarized in Table 2 for the convenience of the readers. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] Indians have the highest rates of coronary artery disease (CAD) incidence, 23 and percutaneous coronary intervention (PCI) is thus a lifesaving option for many CAD patients in India and shows a crucial role in interventional cardiology. 24 According to the National Interventional Council of the Cardiological Society of India, approximately 4,38,351 PCIs are performed each year in India, and this number is on the rise.…”

“…The prevalence of CI-AKI in India has been summarized in Table 2 for the convenience of the readers. 18–31…”

“…Comorbidity is highly prevalent among patients undergoing PCI. [18][19][20][21][22][23][24][25][26][27][28][29][30][31]…”