Efficacy of Remote Ischemic Preconditioning in the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography /Angioplasty

Document Type : Original Article

Authors

Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Contrast-induced nephropathy (CIN) is a significant common complication in patients undergoing coronary angiography. This study was carried out to determine the efficacy of remote ischemic preconditioning in the prevention of CIN in patients undergoing coronary angiography/angioplasty.
 
Methods: This randomized controlled trial assessed 171 eligible patients undergoing coronary angiography/angioplasty in Shariati Hospital between May 2018 and June 2019. The patients were randomly assigned to either the remote ischemic preconditioning group or the control group. The glomerular filtration rate (GFR), CIN, and creatinine levels were compared between the groups.
 
Results: The incidence rate of CIN was 1.2% in the intervention group and 9.4% in the control group (P = 0.018), with a risk ratio of 0.125. There were significant improvements in creatinine and GFR in the intervention group (P = 0.007 and P = 0.001, respectively), while there were no meaningful improvements in creatinine and GFR in the control group. The intervention group featured 11 patients in Stage IV chronic kidney disease, none of whom was CIN-positive, whereas the control group had 2 patients in Stage IV, both of whom were CIN-positive (P < 0.001).
 
Conclusions:The results showed the efficacy of remote ischemic preconditioning in the prevention of CIN, the reduction of creatinine reduction, and the elevation of GFR in patients undergoing coronary angiography/angioplasty. (Iranian Heart Journal 2021; 22(1): 100-105)

Keywords

References

Nash K, Hafeez A, Hou S: Hospital-acquired renal insufficiency. Am J KidneyDis 2002, 39:930–936.
Morcos SK, Thomsen HS, Webb JA: Contrast-media-inducednephrotoxicity: a consensus report. Contrast Media Safety Committee,European Society of Urogenital Radiology (ESUR). EurRadiol 1999,9:1602–1613.
Mitchell AM, Jones AE, Tumlin JA, Kline JA: Incidence of contrast-inducednephropathy after contrast-enhanced computed tomography in theoutpatient setting. Clin J Am SocNephrol 2010, 5:4–9.
From AM, Bartholmai BJ, Williams AW, Cha SS, McDonald FS: Mortalityassociated with nephropathy after radiographic contrast exposure.Mayo ClinProc 2008, 83:1095–1100.
Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, Hewett J: Arandomized prospective trial to assess the role of saline hydration onthe development of contrast nephrotoxicity. Nephron ClinPract 2003,93:C29–C34.
Sendeski MM: Pathophysiology of renal tissue damage by iodinatedcontrast media. ClinExpPharmacolPhysiol 2011, 38:292–299.
Evans RG, Ince C, Joles JA, Smith DW, May CN, O’Connor PM, Gardiner BS:Haemodynamic influences on kidney oxygenation: clinical implicationsof integrative physiology. ClinExpPharmacolPhysiol 2013, 40:106–122.
Hausenloy, D. J. and D. M. Yellon (2008). "Remote ischemic preconditioning: underlying mechanisms and clinical application." Cardiovascular research.
Wever KE, Warle MC, Wagener FA, van der Hoorn JW, Masereeuw R, van derVliet JA, Rongen GA: Remote ischaemic preconditioning by brief hindlimb ischaemia protects against renal ischaemia-reperfusion injury: therole of adenosine. Nephrol Dial Transplant 2011, 26:3108–3117.
Przyklenk, K., et al. (1993). "Regional ischemic'preconditioning'protects remote virgin myocardium from subsequent sustained coronary occlusion." Circulation 87(3): 893-899.
Er, F., et al. (2012). "Ischemic preconditioning for prevention of contrast-medium-induced nephropathy: randomized pilot RenPro-trial (renal protection trial)." Circulation: CIRCULATIONAHA. 112.096370.
Mann, D. L., et al. (2014). Braunwald's heart disease: a textbook of cardiovascular medicine, Elsevier Health Sciences.
Er, F., et al. (2012). "Ischemic preconditioning for prevention of contrast-medium-induced nephropathy: randomized pilot RenPro-trial (renal protection trial)." Circulation: CIRCULATIONAHA. 112.096370.
Whittaker, P. and K. Przyklenk (2011). "Remote-conditioning ischemia provides a potential approach to mitigate contrast medium-induced reduction in kidney function: a retrospective observational cohort study." Cardiology 119(3): 145-150.
Zarbock, A., et al. (2015). "Effect of remote ischemic preconditioning on kidney injury among high-risk patients undergoing cardiac surgery: a randomized clinical trial." Jama 313(21): 2133-2141.
Thomas B Sterenborg ., et al.(2014). "Remote ischemic preconditioning to reduce contrast-induced nephropathy: study protocol for a randomized controlled trial"Trials 2014, 15:119
SanazSoleymani., et al.(2019). "Is there a protective effect with remote ischemic preconditioning on contrast-induced acute renal injury after coronaryangiography in low-risk patients?"J Nephropathol. 2019;8(4):e38.
Gillian Balbir Singh., et al.(2016). "Remote Ischemic Preconditioning for thePrevention  of Contrast-Induced Acute Kidney  Injury in Diabetics Receiving Elective Percutaneous Coronary Intervention "PLoS ONE 11(10): e0164256. doi:10.1371/journal.pone.0164256.
SanjaiPattuValappil., et al. "Remote ischemic preconditioning for prevention of contrast induced nephropathy—Insights from an Indian study". Indian Heart Journal 70 (2018) 857–863.
Tintinalli JE. Tintinalli’s emergency medicine: a comprehensive study guide. 7th edition. 2011
Iranian Heart Journal
Volume 22, Issue 1
Winter 2021
Pages 100-105

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