Remote Ischemic Preconditioning for the Prevention of Contrast-Induced Acute Kidney Injury in Diabetics Receiving Elective Percutaneous Coronary Intervention
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-repe...
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| Published in | PloS one Vol. 11; no. 10; p. e0164256 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
Public Library of Science
10.10.2016
Public Library of Science (PLoS) |
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| Abstract | 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. |
|---|---|
| AbstractList | 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 [less than or equal to]60 ml/min/1.73 m.sup.2 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. 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. Objective 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. Methods This randomized, double-blind, sham-controlled study enrolled patients with diabetes scheduled for elective PCI with eGFR less than or equal to 60 ml/min/1.73 m2 or urinary albumin creatinine ratio of >300 mg/g to receive either RIPC or the sham ischemic preconditioning. Results One hundred and two patients (68.9 plus or minus 8.2 years old, 47.1% men) were included. Baseline eGFR, creatinine and serum NGAL was similar between RIPC and control groups (48.5 plus or minus 12 ml/min vs. 46.6 plus or minus 10 ml/min, p = 0.391; 1.42 plus or minus 0.58 mg/dl vs. 1.41 plus or minus 0.34 mg/dl, p = 0.924; and 136.0 plus or minus 45.0 ng/ml vs. 137.6 plus or minus 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. Conclusions In this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD. Trial Registration ClinicalTrials.gov NCT02329444 Objective 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. Methods 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. Results 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. Conclusions In this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD. Trial Registration ClinicalTrials.gov NCT02329444 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. Objective 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. Methods This randomized, double-blind, sham-controlled study enrolled patients with diabetes scheduled for elective PCI with eGFR ≤60 ml/min/1.73 m 2 or urinary albumin creatinine ratio of >300 mg/g to receive either RIPC or the sham ischemic preconditioning. Results 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. Conclusions In this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD. Trial Registration ClinicalTrials.gov NCT02329444 Objective 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. Methods This randomized, double-blind, sham-controlled study enrolled patients with diabetes scheduled for elective PCI with eGFR [less than or equal to]60 ml/min/1.73 m.sup.2 or urinary albumin creatinine ratio of >300 mg/g to receive either RIPC or the sham ischemic preconditioning. Results 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. Conclusions In this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD. Trial Registration ClinicalTrials.gov NCT02329444 OBJECTIVERemote 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.METHODSThis 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.RESULTSOne 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.CONCLUSIONSIn this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD.TRIAL REGISTRATIONClinicalTrials.gov NCT02329444. |
| Audience | Academic |
| Author | Choi, Jung Il Kim, Eun-Sook Ann, Soe Hee Kim, Shin-Jae Shin, Eun-Seok Balbir Singh, Gillian Chung, Hyun Chul Park, Jongha Lee, Jong Soo Lee, Jiho |
| AuthorAffiliation | 1 Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea 3 Division of Endocrinology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea 2 Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea 4 Department of Occupational & Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea Kurume University School of Medicine, JAPAN |
| AuthorAffiliation_xml | – name: 1 Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – name: 3 Division of Endocrinology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – name: Kurume University School of Medicine, JAPAN – name: 4 Department of Occupational & Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – name: 2 Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea |
| Author_xml | – sequence: 1 givenname: Gillian surname: Balbir Singh fullname: Balbir Singh, Gillian organization: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 2 givenname: Soe Hee surname: Ann fullname: Ann, Soe Hee organization: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 3 givenname: Jongha surname: Park fullname: Park, Jongha organization: Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 4 givenname: Hyun Chul surname: Chung fullname: Chung, Hyun Chul organization: Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 5 givenname: Jong Soo surname: Lee fullname: Lee, Jong Soo organization: Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 6 givenname: Eun-Sook surname: Kim fullname: Kim, Eun-Sook organization: Division of Endocrinology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 7 givenname: Jung Il surname: Choi fullname: Choi, Jung Il organization: Division of Endocrinology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 8 givenname: Jiho surname: Lee fullname: Lee, Jiho organization: Department of Occupational & Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 9 givenname: Shin-Jae surname: Kim fullname: Kim, Shin-Jae organization: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea – sequence: 10 givenname: Eun-Seok surname: Shin fullname: Shin, Eun-Seok organization: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27723839$$D View this record in MEDLINE/PubMed |
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| Copyright | COPYRIGHT 2016 Public Library of Science 2016 Balbir Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2016 Balbir Singh et al 2016 Balbir Singh et al |
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| DOI | 10.1371/journal.pone.0164256 |
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| DocumentTitleAlternate | Remote Ischemic Preconditioning for Contrast Nephropathy |
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| Editor | Fukumoto, Yoshihiro |
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| Notes | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 Conceptualization: GBS SHA JP ESS HCC JSL ESK JIC. Data curation: GBS JP ESS. Formal analysis: GBS SHA JP ESS. Investigation: GBS SHA JP HCC JSL ESK JIC SJK ESS. Methodology: ESS JP GBS SHA HCC JSL ESK JLC. Project administration: GBS ESS. Resources: GBS SHA SJK HCC JP JSL ESK JLC. Software: JP HCC JSL. Supervision: ESS JP JL. Validation: JP GBS SHA HCC JSL ESK JIC. Visualization: GBS SHA JP. Writing – original draft: GBS SHA JP ESS. Writing – review & editing: GBS SHA JP ESS JL SJK. Competing Interests: The authors have declared that no competing interests exist. |
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| Snippet | Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a subsequent... Objective Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a... OBJECTIVERemote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a subsequent... Objective Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a... |
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| SubjectTerms | 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 |
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| Title | Remote Ischemic Preconditioning for the Prevention of Contrast-Induced Acute Kidney Injury in Diabetics Receiving Elective Percutaneous Coronary Intervention |
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