Remote Ischemic Preconditioning for the Prevention of Contrast-Induced Acute Kidney Injury in Diabetics Receiving Elective Percutaneous Coronary Intervention

• Published in: PloS one Vol. 11; no. 10; p. e0164256
• Main Authors: Balbir Singh, Gillian, Ann, Soe Hee, Park, Jongha, Chung, Hyun Chul, Lee, Jong Soo, Kim, Eun-Sook, Choi, Jung Il, Lee, Jiho, Kim, Shin-Jae, Shin, Eun-Seok
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.10.2016; Public Library of Science (PLoS)
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - prevention & control; Aged; Albumin; Angioplasty; Balloon angioplasty; Biology and Life Sciences; Blood flow; C-Reactive Protein - analysis; Calcium-binding protein; Cardiology; Chronic kidney failure; Contrast agents; Contrast Media - adverse effects; Coronary Disease - therapy; Coronary vessels; Creatine Kinase, MB Form - blood; Creatinine; Creatinine - blood; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - pathology; Diabetes therapy; Diabetics; Disease control; Disease prevention; Double-Blind Method; Endocrinology; Enzymes; Epidermal growth factor receptors; Female; Glomerular Filtration Rate; Heart diseases; Humans; Injury prevention; Intervention; Ischemia; Ischemic Preconditioning; Kidney - blood supply; Kidney diseases; Kidneys; Lipocalin-2 - blood; Male; Medical imaging; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Nephrology; Neutrophils; Occlusion; Patients; Percutaneous Coronary Intervention; Preconditioning; Prevention; Reperfusion; Signal transduction; Troponin; Troponin T; Troponin T - blood; Type 2 diabetes
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0164256

Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a subsequent ischemia-reperfusion injury. When RIPC is applied before percutaneous coronary intervention (PCI), the kidneys may be protected against ischemia-reperfusion injury and subsequently contrast-induced acute kidney injury (CI-AKI). The aim of this study was to evaluate the efficacy of RIPC for the prevention of CI-AKI in patients with diabetes with pre-existing chronic kidney disease (CKD) undergoing elective PCI. This randomized, double-blind, sham-controlled study enrolled patients with diabetes scheduled for elective PCI with eGFR ≤60 ml/min/1.73 m2 or urinary albumin creatinine ratio of >300 mg/g to receive either RIPC or the sham ischemic preconditioning. One hundred and two patients (68.9 ± 8.2 years old, 47.1% men) were included. Baseline eGFR, creatinine and serum NGAL was similar between RIPC and control groups (48.5 ± 12 ml/min vs. 46.6 ± 10 ml/min, p = 0.391; 1.42 ± 0.58 mg/dl vs. 1.41 ± 0.34 mg/dl, p = 0.924; and 136.0 ± 45.0 ng/ml vs. 137.6 ± 43.3 ng/ml, p = 0.961, respectively). CI-AKI occurred in 13.7% (14/102) of the total subjects, with both RIPC and control groups having an equal incidence of 13.7% (7/51). No significant differences were seen in creatinine, NGAL, cardiac enzymes (troponin T, CKMB) and hs-CRP between the groups post-procedure. In this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD. ClinicalTrials.gov NCT02329444.