Randomized controlled trial of remote ischemic preconditioning in children having cardiac surgery

• Published in: Journal of cardiothoracic surgery Vol. 19; no. 1; p. 5
• Main Authors: Law, Yuk M, Hsu, Christine, Hingorani, Sangeeta R, Richards, Michael, McMullan, David M, Jefferies, Howard, Himmelfarb, Jonathan, Katz, Ronit
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.01.2024; BioMed Central; BMC
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - prevention & control; Age; Blood pressure; Brain natriuretic peptide; Cardiac Surgical Procedures - adverse effects; Cardiothoracic surgery; Care and treatment; Child; Child, Preschool; Children; Congenital diseases; Congenital heart disease; Coronary artery bypass; Creatinine; Cystatin C; Genetic disorders; Glomerular filtration rate; Health aspects; Heart diseases; Heart surgery; Human subjects; Humans; Injury prevention; Ischemia; Ischemic Preconditioning; Ischemic Preconditioning, Myocardial; Kidney injury; Kidneys; Natriuretic peptides; Pediatric cardiology; Pediatrics; Plasma; Population studies; Preconditioning; Remote ischemic preconditioning; Risk; Surgery; Troponin I; Ultrasonic imaging; Cardiothoracic surgery; Remote ischemic preconditioning; Congenital heart disease; Children; Kidney injury
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-023-02450-8

Children undergoing cardiac surgery are at risk for acute kidney injury (AKI) and cardiac dysfunction. Opportunity exists in protecting end organ function with remote ischemic preconditioning. We hypothesize this intervention lessens kidney and myocardial injury. We conducted a randomized, double blind, placebo controlled trial of remote ischemic preconditioning in children undergoing cardiac surgery. Pre-specified end points are change in creatinine, estimated glomerular filtration rate, development of AKI, B-type natriuretic peptide and troponin I at 6, 12, 24, 48, 72 h post separation from bypass. There were 45 in the treatment and 39 patients in the control group, median age of 3.5 and 3.8 years, respectively. There were no differences between groups in creatinine, cystatin C, eGFR at each time point. There was a trend for a larger rate of decrease, especially for cystatin C (p = 0.042) in the treatment group but the magnitude was small. AKI was observed in 21 (54%) of control and 16 (36%) of treatment group (p = 0.094). Adjusting for baseline creatinine, the odds ratio for AKI in treatment versus control was 0.31 (p = 0.037); adjusting for clinical characteristics, the odds ratio was 0.34 (p = 0.056). There were no differences in natriuretic peptide or troponin levels between groups. All secondary end points of clinical outcomes were not different. There is suggestion of RIPC delivering some kidney protection in an at-risk pediatric population. Larger, higher risk population studies will be required to determine its efficacy. Trial registration and date: Clinicaltrials.gov NCT01260259; 2021.