Remote ischemic preconditioning reduces rate of acute kidney injury after cardiac surgery

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 - Surgery

Patients undergoing cardiac surgery who received remote ischemic preconditioning had a significant reduction in the rate of acute kidney injury and the use of renal replacement therapy, according to a multicenter, double-blind, randomized trial in Germany.

Lead researcher Alexander Zarbock, MD, of the University Hospital Münster in Germany, and colleagues published their findings online in the Journal of the American Medical Association on May 29.

Previous studies found that as many as 30 percent of patients developed acute kidney injury after cardiac surgery and that acute kidney injury significantly affected mortality and morbidity.

In this trial, Zarbock et al included 240 patients who had undergone cardiac surgery at four hospitals between August 2013 and June 2014 and were at high risk for acute kidney injury. The mean age was approximately 70, and approximately 75 percent of patients were males.

Patients were randomized to receive remote ischemic preconditioning or be in the control group. Remote ischemic preconditioning consisted of three cycles of five-minute ischemia and five-minute reperfusion in one upper arm after anesthesia.

Within 72 hours after the surgery, 37.5 percent of patients in the remote ischemic preconditioning group and 52.5 percent of patients in the control group developed acute kidney injury. Moderate and severe acute kidney injury cases were found in 12.5 percent of the remote ischemic preconditioning group and 25.8 percent of patients in the control group, while mild acute kidney injury cases occurred in 25 percent and 26.7 percent of patients, respectively.

Researchers also found 5.8 percent of patients in the remote ischemic preconditioning group and 15.8 percent of patients in the control group used renal replacement therapy. Patients undergoing remote ischemic preconditioning had a shorter stay in the intensive care unit, as well.

There was no significant difference between the groups in terms of in-hospital mortality, 30-day mortality, length of hospital stay, MI, perioperative stroke or use of mechanical ventilation.