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ORIGINAL ARTICLE
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Remote ischemic preconditioning for prevention of contrast-induced acute kidney injury in patients of CKD stage III and IV undergoing elective coronary angiography: A randomized controlled trial


1 Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
2 Department of Cardiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India

Correspondence Address:
Dipankar Sircar,
Associate Professor Department of Nephrology Institute of Postgraduate Medical Education and Research, 244, AJC Bose Road, Kolkata 700060 West Bengal
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijn.IJN_416_19

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a serious complication of coronary angiography (CA). The aim of this randomized, parallel group, single blind, sham-controlled trial was to assess the safety and efficacy of the remote ischemic preconditioning on the prevention of CI-AKI. Methods: Patients of 18–80 years of age with CKD 3 and 4, who were admitted for elective coronary angiography in a tertiary care hospital in eastern India were randomized in a 1:1 ratio to standard care with ischemic preconditioning (n = 45; intermittent arm ischemia through 4 cycles of 5-min inflation and 5-min deflation of a blood pressure cuff) or with standard care and sham ischemic preconditioning (n = 42). Overall, both study groups were at moderate risk of developing CI-AKI according to the Mehran risk score. The primary endpoint was the incidence of CI-AKI, defined as an increase in serum creatinine ≥25' or ≥0.5 mg/dL above baseline at 48 h after contrast medium exposure. Results: CI-AKI occurred in 8 patients (19.04') in the control group and 2 (4.4') in the remote ischemic preconditioning group (odds ratio, 0.198, 95' confidence interval, 0.087 to 0.452; P = 0.04). No major adverse events were related to remote ischemic preconditioning. Conclusions: This study indicates that remote ischemic preconditioning is a simple and well-tolerated procedure, which reduces the incidence of CI-AKI in CKD 3 and 4 patients undergoing coronary angiography.


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    -  Sahu R
    -  Sircar D
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Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07