The Effect of Remote Ischemic Preconditioning on Serum Creatinine in Patients Undergoing Partial Nephrectomy: A Randomized Controlled Trial

Abstract

Renal function declines after partial nephrectomy due to ischemic reperfusion injury induced by surgical insult or renal artery clamping. The effect of remote ischemic preconditioning (RIPC) on reducing renal injury after partial nephrectomy has not been studied regarding urinary biomarkers. Eighty-one patients undergoing partial nephrectomy were randomly assigned to either RIPC or the control group. RIPC protocol consisted of four cycles of five-min inflation and deflation of a blood pressure cuff to 250 mmHg. Serum creatinine levels were compared at the following time points: preoperative baseline, immediate postoperative, on the first and third days after surgery, and two weeks after surgery. The incidence of acute kidney injury, other surgical complication rates, and urinary biomarkers, including urine creatinine, β-2 microglobulin, microalbumin, and N-acetyl-beta-D-glucosaminidase were compared. Split renal functions measured by renal scan were compared up to 18 months after surgery. There was no significant difference in the serum creatinine level on the first postoperative day (median (interquartile range) 0.87 mg/dL (0.72–1.03) in the RIPC group vs. 0.92 mg/dL (0.71–1.12) in the control group, p = 0.728), nor at any other time point. There was no significant difference in the incidence of acute kidney injury. Secondary outcomes, including urinary biomarkers, were not significantly different between the groups. RIPC showed no significant effect on the postoperative serum creatinine level of the first postoperative day. We could not reveal any significant difference in the urinary biomarkers and clinical outcomes. However, further larger randomized trials are required, because our study was not sufficiently powered for the secondary outcomes.

Efficacy of remote ischaemic preconditioning on outcomes following non-cardiac non-vascular surgery: a systematic review and meta-analysis

“…There was no difference between the intervention and control groups (MD 1.22 mL/min/1.73 m 2 , 95% CI - 0.65 to 3.09, p = 0.20) (Supplemental Fig. 1 ) (Bang et al 2019 ; Chung et al 2021 ; Huang et al 2013 ; Nicholson et al 2015 ; Nielsen et al 2019 ; Hou et al 2017 ; MacAllister et al 2015 ).…”

“…Random effects meta-analysis showed a lower postoperative serum creatinine in the intervention group, mean difference (MD) - 3.81 µmol/L, 95% CI - 6.79 to - 0.83, p = 0.01, I 2 = 5%) (Fig. 3 B) (Antonowicz et al 2018 ; Park et al 2018 ; Bang et al 2019 ; Chung et al 2021 ; Chen et al 2013 ; Huang et al 2013 ; Nicholson et al 2015 ; Nielsen et al 2019 ; Oh et al 2017 ).…”

“…The incidence of postoperative acute kidney injury (AKI) was reported in 5 studies that included the following patient groups: patients undergoing nephrectomy, liver resection, orthopedic surgery, and liver transplant recipients (Park et al 2018 ; Bang et al 2019 ; Robertson et al 2017 ; Teo et al 2020 ; Chung et al 2021 ). Three of the studies used the KDIGO criteria for the definition of AKI, one used the AKIN criteria and one used change in serum creatinine.…”

“…Fifteen studies evaluated the postoperative length of stay (Antonowicz et al 2018 ; Ekeloef et al 2019 ; Zeggeren et al 2021 ; Robertson et al 2017 ; Chung et al 2021 ; Chen et al 2013 ; Nicholson et al 2015 ; MacAllister et al 2015 ; Li et al 2014 ; Lin et al 2010 ; Jung et al 2020 ; Liu et al 2019 ; He et al 2017 ; Krogstrup et al 2017 ; Memtsoudis et al 2014 ). There was a small but statistically significant difference favoring the intervention group, MD - 0.99 days, 95% CI - 1.75 to - 0.23, p = 0.01, I 2 = 88% (Supplemental Fig.…”

“…Sixteen studies commented on the presence of adverse events related to RIPC (Antonowicz et al 2018 ; Ekeloef et al 2019 ; Zeggeren et al 2021 ; Teo et al 2020 ; Chung et al 2021 ; Chen et al 2013 ; Huang et al 2013 ; Nicholson et al 2015 ; MacAllister et al 2015 ; Lin et al 2014 ; Kanoria et al 2017 ; Oh et al 2020 ; Tosun et al 2021 ; Krogstrup et al 2017 ; Krag et al 2019 ; Wang et al 2018 ). Four studies identified adverse events, most of which were transient local erythema, petechiae, or bruising (Chen et al 2013 ; Nicholson et al 2015 ; MacAllister et al 2015 ; Krogstrup et al 2017 ).…”