Remote Ischemic Preconditioning to Prevent Contrast-Associated Kidney Injury in Elective Coronary Angiogram: A Randomized Controlled Trial
Papatsiri Suntavaruk, โสฬส จาตุรพิศาลนุกูล, สาธิต คูระทอง, วันจักร พงษ์สิทธิศักดิ์*
Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; Email: [email protected]
OBJECTIVE: Remote ischemic preconditioning (RIPC) is a new strategy to prevent organ injury from oxidative stress and ischemic reperfusion injury, particularly for the kidney, heart, and brain. Contrast-associated acute kidney injury (CA-AKI) is a complication of coronary angiography (CAG). Based on previous studies, whether RIPC prevents CA-AKI post-CAG remains unclear. Therefore, this study aims to compare the efficacy of standard (std) management and standard management with RIPC to prevent CA-AKI post-CAG.
METHODS: This study was an open-label 1:1 randomized controlled trial. The elective CAG patients with an estimated glomerular filtration rate of 15–45 mL/min/1.73 m2 were enrolled. For the RIPC group, patients performed RIPC starting from inflating manual cuff pressure to 200 mmHg for 5 min on an extremity and then deflating 5 min alternate to four times before coronary angiogram at least 1 hr. All patients had received the usual standard management of pre-CAG. The AKI outcomes were evaluated at 48 hrs and 1 week post-CAG. The adverse events were also assessed.
RESULTS: A total of 27 patients (RIPC group = 14, std group = 13) were enrolled in this study. Baseline characteristics were comparable between both groups except for male gender was higher in the RIPC group (std group 7 [53.85%] and RIPC group 11 [78.57%]), in part of the amount of contrast media volume and procedure duration was higher in the std group (mean contrast volume are 140 [120] mL in the std group and 40.00 [31.25] mL in the RIPC group). No AKI event was observed in the RIPC group. By contrast, AKI in the std group at 48 hrs included two (15.4%) participants and one (7.7%) participant at 1 week. Serious adverse events were not observed in both groups.
CONCLUSION: RIPC may be implemented as a systematic strategy to prevent CA-AKI post-CAG. Some researchers tend to improve CA-AKI. Further studies in a larger number of participants may verify the benefit of RIPC and provide definite conclusion.
Vajira Medical Journal: Journal of Urban Medicine ปี 2566, January-March ปีที่: 67 ฉบับที่ 1 หน้า 481-488
acute kidney injury, Remote ischemic preconditioning, contrast media, coronary angiogram