Remote ischemic preconditioning has a neutral effect on the incidence of kidney injury after coronary artery bypass graft surgery

• Published in: Kidney international Vol. 87; no. 2; pp. 473 - 481
• Main Authors: Gallagher, Sean M., Jones, Dan A., Kapur, Akhil, Wragg, Andrew, Harwood, Steve M., Mathur, Rohini, Archbold, R Andrew, Uppal, Rakesh, Yaqoob, Muhammad M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015; Elsevier Limited
• Subjects: acute kidney injury; Acute Kidney Injury - etiology; Acute Kidney Injury - metabolism; Acute Kidney Injury - prevention & control; Aged; Aged, 80 and over; Biomarkers - blood; Biomarkers - urine; cardiovascular disease; chronic kidney disease; Coronary Artery Bypass - adverse effects; Creatinine - blood; Female; Forearm - blood supply; Humans; ischemia–reperfusion; Ischemic Preconditioning - methods; Male; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - metabolism; Postoperative Complications - prevention & control; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - surgery; Reperfusion Injury - etiology; Reperfusion Injury - metabolism; Reperfusion Injury - prevention & control; Troponin T - blood; cardiovascular disease; chronic kidney disease; acute kidney injury; ischemia–reperfusion
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.2014.259

Acute kidney injury (AKI) is a frequent complication of cardiac surgery and usually occurs in patients with preexisting chronic kidney disease (CKD). Remote ischemic preconditioning (RIPC) may mitigate the renal ischemia–reperfusion injury associated with cardiac surgery and may be a preventive strategy for postsurgical AKI. We undertook a randomized controlled trial of RIPC to prevent AKI in 86 patients with CKD (estimated glomerular filtration rate under 60ml/min per 1.73m2) undergoing coronary artery bypass graft (CABG) surgery. Forty-three patients each were randomized to receive standard care with or without RIPC consisting of three 5-minute cycles of forearm ischemia followed by reperfusion. The primary end point was the development of AKI defined as an increase in serum creatinine concentration over 0.3mg/dl within 48h of surgery. Secondary end points included a comparison between the study and control groups of several serum biomarkers of renal injury including cystatin-C, neutrophil gelatinase–associated lipocalin (NGAL), and interleukin-18 (IL-18), and urinary biomarkers including NGAL, IL-18, and kidney injury molecule-1 measured at 6, 12, and 24h after CABG, and the 72-h serum troponin T concentration area under the curve as a marker of myocardial injury. Clinical and operative characteristics were similar between the preconditioned and control groups. AKI developed in 12 patients in both groups within 48h of CABG. There were no significant differences between the two groups in the concentrations of any of the serum or urinary biomarkers of renal or cardiac injury after CABG. Thus, RIPC induced by forearm ischemia–reperfusion had no effect on the frequency of AKI after CABG in patients with CKD.