Response to Commentary on ‘Remote Ischemic Preconditioning to Reduce Contrast Induced Nephropathy: A Randomized Controlled Trial’

Abstract

Re. "Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease" We read with interest the paper by Sigterman et al. about the incidence and consequences of contrast induced nephropathy (CIN) in symptomatic peripheral arterial disease (PAD) patients who were treated by endovascular procedures. 1 To limit the recurrence of CIN, the authors suggest increasing research into potential alternatives that would remove the need for contrast administration. We would like to underscore that remote ischemic preconditioning (RIPC), performed by cycles of alternating 5 minute inflation and 5 minute deflation of a standard upper arm blood pressure cuff before the injection of contrast is an interesting prophylactic method. 2 Indeed, studies have shown that RIPC prevents CIN in patients at high or moderate CIN risk based on Mehran score (12 vs. 40%, p ¼ .002, and 10 vs. 36%, p ¼ .003, respectively). 3,4 In our opinion, future research should also focus on RIPC for the prevention of acute kidney injury and improved PAD patient outcomes as RIPC is a non-invasive, cheap, easy, and safe method.