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Remote Ischemic Preconditioning To Reduce Contrast-Induced Nephropathy: A Randomized Controlled Trial.
Eur J Vasc Endovasc Surg 2015; 50(4):527-32EJ

Abstract

BACKGROUND

Despite the increasing use of pre- and post-hydration protocols and low osmolar instead of high osmolar iodine containing contrast media, the incidence of contrast induced nephropathy (CIN) is still significant. There is evidence that contrast media cause ischemia reperfusion injury of the renal medulla. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low cost method to reduce ischemia reperfusion injury. The aim of this study is to investigate whether RIPC, as an adjunct to standard preventive measures, reduces contrast induced acute kidney injury in patients at risk of CIN.

METHODS

The RIPCIN study is a multicenter, single blinded, randomized controlled trial in which 76 patients at risk of CIN received standard hydration combined with RIPC or hydration with sham preconditioning. RIPC was applied by four cycles of 5 min ischemia and 5 min reperfusion of the forearm. The primary outcome measure was the change in serum creatinine from baseline to 48 to 72 hours after contrast administration.

RESULTS

With regard to the primary endpoint, no significant effect of RIPC was found. CIN occurred in four patients (2 sham and 2 RIPC). A pre-defined subgroup analysis of patients with a Mehran risk score ≥11, showed a significantly reduced change in serum creatinine from baseline to 48 to 72 hours in patients allocated to the RIPC group (Δ creatinine -3.3 ± 9.8 μmol/L) compared with the sham group (Δ creatinine +17.8 ± 20.1 μmol/L).

CONCLUSION

RIPC, as an adjunct to standard preventive measures, does not improve serum creatinine levels after contrast administration in patients at risk of CIN according to the Dutch guideline. However, the present data indicate that RIPC might have beneficial effects in patients at a high or very high risk of CIN (Mehran score ≥ 11). The RIPCIN study is registered at: http://www.controlled-trials.com/ISRCTN76496973.

Authors+Show Affiliations

Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Epidemiology Biostatistics and HTA, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Surgery, Division of Vascular Surgery, Slingeland Hospital, Doetinchem, The Netherlands.Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Michiel.Warle@radboudumc.nl.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

26015372

Citation

Menting, T P., et al. "Remote Ischemic Preconditioning to Reduce Contrast-Induced Nephropathy: a Randomized Controlled Trial." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 50, no. 4, 2015, pp. 527-32.
Menting TP, Sterenborg TB, de Waal Y, et al. Remote Ischemic Preconditioning To Reduce Contrast-Induced Nephropathy: A Randomized Controlled Trial. Eur J Vasc Endovasc Surg. 2015;50(4):527-32.
Menting, T. P., Sterenborg, T. B., de Waal, Y., Donders, R., Wever, K. E., Lemson, M. S., ... Warlé, M. C. (2015). Remote Ischemic Preconditioning To Reduce Contrast-Induced Nephropathy: A Randomized Controlled Trial. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 50(4), pp. 527-32. doi:10.1016/j.ejvs.2015.04.002.
Menting TP, et al. Remote Ischemic Preconditioning to Reduce Contrast-Induced Nephropathy: a Randomized Controlled Trial. Eur J Vasc Endovasc Surg. 2015;50(4):527-32. PubMed PMID: 26015372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Remote Ischemic Preconditioning To Reduce Contrast-Induced Nephropathy: A Randomized Controlled Trial. AU - Menting,T P, AU - Sterenborg,T B, AU - de Waal,Y, AU - Donders,R, AU - Wever,K E, AU - Lemson,M S, AU - van der Vliet,J A, AU - Wetzels,J F, AU - SchultzeKool,L J, AU - Warlé,M C, Y1 - 2015/05/23/ PY - 2014/09/22/received PY - 2015/04/06/accepted PY - 2015/5/28/entrez PY - 2015/5/28/pubmed PY - 2015/12/15/medline KW - Acute kidney injury – pre- and post-hydration KW - Contrast induced nephropathy KW - Randomized controlled trial KW - Remote ischemic preconditioning SP - 527 EP - 32 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 50 IS - 4 N2 - BACKGROUND: Despite the increasing use of pre- and post-hydration protocols and low osmolar instead of high osmolar iodine containing contrast media, the incidence of contrast induced nephropathy (CIN) is still significant. There is evidence that contrast media cause ischemia reperfusion injury of the renal medulla. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low cost method to reduce ischemia reperfusion injury. The aim of this study is to investigate whether RIPC, as an adjunct to standard preventive measures, reduces contrast induced acute kidney injury in patients at risk of CIN. METHODS: The RIPCIN study is a multicenter, single blinded, randomized controlled trial in which 76 patients at risk of CIN received standard hydration combined with RIPC or hydration with sham preconditioning. RIPC was applied by four cycles of 5 min ischemia and 5 min reperfusion of the forearm. The primary outcome measure was the change in serum creatinine from baseline to 48 to 72 hours after contrast administration. RESULTS: With regard to the primary endpoint, no significant effect of RIPC was found. CIN occurred in four patients (2 sham and 2 RIPC). A pre-defined subgroup analysis of patients with a Mehran risk score ≥11, showed a significantly reduced change in serum creatinine from baseline to 48 to 72 hours in patients allocated to the RIPC group (Δ creatinine -3.3 ± 9.8 μmol/L) compared with the sham group (Δ creatinine +17.8 ± 20.1 μmol/L). CONCLUSION: RIPC, as an adjunct to standard preventive measures, does not improve serum creatinine levels after contrast administration in patients at risk of CIN according to the Dutch guideline. However, the present data indicate that RIPC might have beneficial effects in patients at a high or very high risk of CIN (Mehran score ≥ 11). The RIPCIN study is registered at: http://www.controlled-trials.com/ISRCTN76496973. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/26015372/Remote_Ischemic_Preconditioning_To_Reduce_Contrast_Induced_Nephropathy:_A_Randomized_Controlled_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(15)00240-3 DB - PRIME DP - Unbound Medicine ER -