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

Stokfisz, Karolina; Ledakowicz-Polak, Anna; Zagórski, Maciej; Jander, Sławomir; Przybylak, Katarzyna; Zielińska, Marzenna

doi:10.17219/acem/112610

Cited by 7 publications

(8 citation statements)

References 41 publications

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“…Patients with normal kidney function at baseline were included except one study that included patients with chronic kidney disease (CKD) who were scheduled for cardiac surgery (17). With regard to the surgery procedures, 20 studies included patients who received on-pump surgeries (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)30), while the remaining two studies included patients who received off-pump surgeries (29,31). Proportions of diabetic patients varied among the included studies, and patients with severe cardiac systolic function (left ventricular ejection fraction <30%) were rarely included.…”

Section: Search Resultsmentioning

confidence: 99%

“…Uninflated cuffs were used on patients in the control group. Most of the studies used the AKIN definition of AKI, while the RIFLE (13,19,28) and the KDIGO (18,20,30,31) definitions were used in three and four studies, respectively. Table 2 shows the details of study quality evaluation.…”

Section: Search Resultsmentioning

confidence: 99%

“…Although, these results were also inconsistent (35). Many RCTs have been published since 2016 (22,(24)(25)(26)(27)(28)(29)(30)(31), warranting an updated meta-analysis. In addition, the potential impacts of study and patient features on the efficacy of RIPC on postoperative AKI in these patients were rarely analyzed.…”

Section: Introductionmentioning

confidence: 99%

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Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Zigang

Yong-mei

Lei

et al. 2021

Front. Cardiovasc. Med.

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Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

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Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

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Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Zigang

Yong-mei

Lei

et al. 2021

Front. Cardiovasc. Med.

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“…Finally, a total of 79 RCTs involving 10,814 patients undergoing cardiac surgery were included in this meta-analysis (Figure 1). 4–8,11–19,26–90…”

Section: Resultsmentioning

confidence: 99%

Remote Ischemic Preconditioning Reduces Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Long

Feng

Shan

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Results from previous studies evaluating the effects of remote ischemic preconditioning (RIPC) on morbidity and mortality after cardiac surgery are inconsistent. This meta-analysis of randomized controlled trials (RCTs) aims to determine whether RIPC improves cardiac and renal outcomes in adults undergoing cardiac surgery. METHODS: PubMed, EMBASE, and Cochrane Library were comprehensively searched to identify RCTs comparing RIPC with control in cardiac surgery. The coprimary outcomes were the incidence of postoperative myocardial infarction (MI) and the incidence of postoperative acute kidney injury (AKI). Meta-analyses were performed using a random-effect model. Subgroup analyses were conducted according to volatile only anesthesia versus propofol anesthesia with or without volatiles, high-risk patients versus non–high-risk patients, and Acute Kidney Injury Network (AKIN) or Kidney Disease Improving Global Outcomes (KDIGO) criteria versus other criteria for AKI diagnosis. RESULTS: A total of 79 RCTs with 10,814 patients were included. While the incidence of postoperative MI did not differ between the RIPC and control groups (8.2% vs 9.7%; risk ratio [RR] = 0.87, 95% confidence interval [CI], 0.76–1.01, P = .07, I2 = 0%), RIPC significantly reduced the incidence of postoperative AKI (22% vs 24.4%; RR = 0.86, 95% CI, 0.77–0.97, P = .01, I2 = 34%). The subgroup analyses showed that RIPC was associated with a reduced incidence of MI in non–high-risk patients, and that RIPC was associated with a reduced incidence of AKI in volatile only anesthesia, in non–high-risk patients, and in the studies using AKIN or KDIGO criteria for AKI diagnosis. CONCLUSIONS: This meta-analysis demonstrates that RIPC reduces the incidence of AKI after cardiac surgery. This renoprotective effect of RIPC is mainly evident during volatile only anesthesia, in non–high-risk patients, and when AKIN or KDIGO criteria used for AKI diagnosis.

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“…( 20,21 ) However, our observations in SLKT recipients contrast with those studies. There may be some explanations for our observations: (1) ischemic preconditioning and ischemic injury in a donor’s kidney possibly protecting the allograft from subsequent posttransplant ischemic injury, ( 22 ) (2) the duration and etiology of AKI, (3) the careful selection of donors with beneficial characteristics (such as a younger age and greater nephron mass), and (4) urine output before recovery. In our study, >80% of donors were nonoliguric before recovery surgery.…”

Section: Discussionmentioning

confidence: 98%

Outcomes of Simultaneous Liver‐Kidney Transplantation Using Kidneys of Deceased Donors With Acute Kidney Injury

Batra¹,

Ariyamuthu

MacConmara³

et al. 2022

Liver Transpl

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Outcomes from simultaneous liver-kidney transplantation (SLKT) when using kidneys from donors with acute kidney injury (AKI) have not been studied. We studied 5344 SLKTs between May 1, 2007, and December 31, 2019, by using Organ Procurement and Transplantation Network registry data supplemented with United Network for Organ Sharing-DonorNet data. Designating a donor as having AKI required by definition that the following criteria were met: (1) the donor's condition aligned with the Kidney Disease: Improving Global Outcomes (KDIGO) international consensus guidelines and the terminal serum creatinine (Scr) level was ≥1.5 times the minimum Scr level for deceased donors before organ recovery and (2) the terminal Scr level was ≥1.5 mg/dL (a clinically meaningful and intuitive Scr threshold for defining AKI for transplant providers). The primary outcomes were liver transplant all-cause graft failure (ACGF; defined as graft failures and deaths) and kidney transplant death-censored graft failure (DCGF) at 1 year after transplant. The donors with AKI were young, had good organ quality, and had a short cold ischemia time. In the study cohort, 4482 donors had no AKI, whereas 862 had AKI (KDIGO AKI stages: 1, n = 521; 2, n = 202; and 3, n = 138). In the group with AKI and the group with no AKI, respectively, liver ACGF at 1 year (11.1% versus 12.9% [P = 0.13]; hazard ratio [HR], 1.20; 95% confidence interval [CI], 0.97-1.49) and kidney DCGF at 1 year (4.6% versus 5.7% [P = 0.18]; HR, 1.27; 95% CI, 0.95-1.70) did not differ in the full multivariable Cox proportional hazard models. Selected kidneys from deceased donors with AKI can be considered for SLKT.

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

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

Cited by 7 publications

References 41 publications

Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Remote Ischemic Preconditioning Reduces Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Outcomes of Simultaneous Liver‐Kidney Transplantation Using Kidneys of Deceased Donors With Acute Kidney Injury

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