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Delayed Remote Ischemic Preconditioning for Cardiac Surgery
Quick Takes
- Delayed remote ischemic preconditioning (RIPC) significantly reduced the incidence of AKI within 7 days after surgery but did not provide cardioprotective effects compared with sham conditioning.
- Given significant limitations of the current study, additional larger multicenter, multirace participant trials are indicated to assess the effects of delayed RIPC on AKI, with longer-term clinical outcomes, and mortality in patients undergoing cardiac surgery.
Study Questions:
What is the impact of delayed remote ischemic preconditioning (RIPC) on the occurrence of acute kidney injury (AKI) and postoperative complications in patients undergoing cardiac surgery?
Methods:
The investigators conducted a prospective, single-center, double-blind, randomized controlled trial involving 509 patients at high risk for AKI who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass. Patients were randomized to receive RIPC (4 cycles of 5-minute inflation and 5-minute deflation on one upper arm with a blood pressure cuff) 24 hours before surgery or a sham condition (control group) that was induced by 4 cycles of 5-minute inflation to a pressure of 20 mm Hg followed by 5-minute cuff deflation. The primary endpoint was the incidence of AKI within the prior 7 days after cardiac surgery. The secondary endpoints included renal replacement therapy during hospitalization, change in urinary biomarkers of AKI and markers of myocardial injury, duration of intensive care unit (ICU) stay and mechanical ventilation, and occurrence of nonfatal myocardial infarction (MI), stroke, and all-cause mortality by day 90. The odds ratio (OR), including 95% confidence interval (CI), for the occurrence of AKI was estimated.
Results:
A total of 509 patients (mean age, 65.2 ± 8.2 years; 348 men [68.4%]) were randomly assigned to the RIPC group (n = 254) or control group (n = 255). AKI was significantly reduced in the RIPC group compared with the control group (69/254 [27.2%] vs. 90/255 [35.3%]; OR, 0.68; 95% CI, 0.47-1.00; p = 0.048). There were no significant between-group differences in the secondary endpoints of perioperative myocardial injury (assessed by the concentrations of cardiac troponin T, creatine kinase myocardial isoenzyme, and NT-proBNP [N-terminal pro–B-type natriuretic peptide]), duration of stay in the ICU and hospital, and occurrence of nonfatal MI, stroke, and all-cause mortality by day 90.
Conclusions:
The authors report that among high-risk patients undergoing cardiac surgery, delayed RIPC significantly reduced the occurrence of AKI.
Perspective:
This study reports that delayed RIPC significantly reduced the incidence of AKI within 7 days after surgery but did not provide cardioprotective effects compared with sham conditioning. Given significant limitations of the current study, additional larger multicenter, multirace participant trials are indicated to assess the effects of delayed RIPC on AKI, with longer-term clinical outcomes, and mortality in patients undergoing cardiac surgery. If validated, this simple, noninvasive application of delayed RIPC in high-risk patients undergoing cardiac surgery would be an attractive strategy.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease
Keywords: Acute Kidney Injury, Cardiac Surgical Procedures, Ischemic Preconditioning
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