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Remote ischemic preconditioning to reduce contrast-induced acute kidney injury in chronic kidney disease: a randomized controlled trial

  • Ghaemian, Ali1
  • Yazdani, Jamshid2
  • Azizi, Soheil3
  • Farsavian, Ali A.1
  • Nabati, Maryam1
  • Malekrah, Alireza1
  • Dabirian, Mozhdeh1
  • Espahbodi, Fatemeh4
  • Mirjani, Bahareh1
  • Mohsenipouya, Hossein5
  • Heshmatian, Javad1
  • 1 Mazandaran Heart Center, Department of Cardiology, Cardiovascular Research Center, Artesh BLVD, Sari, Iran , Sari (Iran)
  • 2 Mazandaran University of Medical Sciences, Faculty of Health Sciences, Sari, Iran , Sari (Iran)
  • 3 Mazandaran University of Medical Sciences, Department of Pathology, Sari, Iran , Sari (Iran)
  • 4 Mazandaran University of Medical Sciences, Department of Internal Medicine and Nephrology, Sari, Iran , Sari (Iran)
  • 5 Mazandaran Heart Center, Cardiovascular Research Center, Artesh BLVD, Sari, Iran , Sari (Iran)
Published Article
BMC Nephrology
Springer (Biomed Central Ltd.)
Publication Date
Dec 22, 2018
DOI: 10.1186/s12882-018-1169-x
Springer Nature


BackgroundThe impact of contrast-induced acute kidney injury (CI-AKI) on patients with chronic renal disease is well-known. Remote ischemic preconditioning (RIPC) is a non-invasive method that can reduce the risk of CI-AKI, but studies on RIPC have had different results. The aim of the present study was to assess the potential impact of RIPC on CI-AKI.MethodsIn a randomized, double blinded, controlled trial, 132 patients with chronic renal dysfunction (glomerular filtration rate < 60 mL/min/m2) who underwent coronary angiography or angioplasty received adequate hydration. RIPC was performed in 66 patients by applying an upper arm blood pressure cuff. The cuff was inflated four times for 5 min to 50 mmHg above the systolic blood pressure, followed by deflation for 5 min. In the control group, the blood pressure cuff was inflated only to 10 mmHg below the patient’s diastolic blood pressure. The primary endpoint was an increase in serum cystatin C ≥ 10% from baseline to 48–72 h after exposure to the contrast.ResultsThe primary endpoint was achieved in 48 (36.4%) patients (24 in each group). RIPC did not show any significant effect on the occurrence of the primary endpoint (P = 1). In addition, when the results were analyzed based on the Mehran risk score for subgroups of patients, RIPC did not reduce the occurrence of the primary endpoint (P = 0.97).ConclusionsIn patients at moderate-to-high risk of developing CI-AKI when an adequate hydration protocol is performed, RIPC does not have an additive effect to prevent the occurrence of CI-AKI.Trial registrationThe clinical trial was registered on (Identification number IRCT2016050222935N2, on December 19, 2016 as a retrospective IRCT).

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