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Prävention der akuten Nierenschädigung nach herzchirurgischen Eingriffen

Entfernte ischämische Präkonditionierung als renoprotektiver Ansatz

Prevention of acute kidney injury after cardiac surgery

Remote ischemic preconditioning as renoprotective approach

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Hintergrund

Die akute Nierenschädigung („acute kidney injury“, AKI) ist eine häufige und schwerwiegende Komplikation nach herzchirurgischen Eingriffen, die mit einer erhöhten Morbidität und Mortalität assoziiert ist. Es gibt derzeit keine effektive Strategie, um eine AKI zu verhindern oder zu therapieren. Die ischämische Fernkonditionierung („remote ischemic preconditioning“, RIPC) ist eine Intervention, die gekennzeichnet ist durch kurze Ischämie- und Reperfusionsphasen eines entfernten Gewebes oder Organs bevor der eigentliche Schaden am Zielorgan stattfindet. Diese einfache und komplikationslose Maßnahme besitzt möglicherweise einen renoprotektiven Ansatz.

Ziel der Arbeit

Die klinische Evidenz der RIPC als mögliche Strategie zur Verhinderung der AKI nach herzchirurgischen Eingriffen sollte evaluiert werden.

Material und Methoden

In einer Literaturrecherche haben wir anhand der aktuellen Studienlage randomisierte kontrollierte Studien untersucht, die den Effekt der RIPC auf die Nierenschädigung analysieren.

Ergebnisse

Die RIPC vermindert bei Hochrisikopatienten die Entstehung einer AKI nach herzchirurgischen Eingriffen. Zwei größere Studien im herzchirurgischen Bereich konnten diese Effekte jedoch nicht bestätigen. Diese beiden Studien weisen aber erhebliche methodische Limitationen auf. Des Weiteren konnte gezeigt werden, dass diese Intervention auch die kontrastmittelinduzierte AKI reduzieren kann.

Schlussfolgerung

Diverse experimentelle und klinische Studien haben den renoprotektiven Effekt der RIPC belegt. Dennoch sind weitere, insbesondere große Studien notwendig, um die adäquate Intensität der Intervention, den molekularen Mechanismus und die Patientenselektion zu untersuchen.

Abstract

Background

Acute kidney injury (AKI) is a common and severe complication following cardiac surgery and is associated with an increased morbidity and mortality. No effective strategy is currently available to prevent or treat AKI. Remote ischemic preconditioning (RIPC) is a non-invasive procedure characterized by brief episodes of ischemia and reperfusion at a remote site before injury of the target organ occurs. This simple and complication-free procedure possibly provides renoprotective effects.

Objectives

The aim of this study was an evaluation of the clinical evidence of RIPC as a strategy for the avoidance of postoperative AKI after cardiothoracic surgery.

Material and methods

A literature search based on the current studies was performed to analyze the effects of RIPC on renal injury.

Results

The RIPC procedure reduces the occurrence of AKI in high-risk patients after cardiac surgery; however, two large trials in the field of cardiac surgery could not confirm this effect. These two studies had, however, substantial methodological limitations. Furthermore, it could be demonstrated that RIPC can also significantly reduce contrast medium-induced AKI.

Conclusion

Diverse experimental and clinical studies have demonstrated a renoprotective effect of RIPC; however, further randomized controlled, multicenter trials are required to analyze the appropriate intensity, evaluate the molecular mechanism and patient selection for this intervention.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Geb. A1, 48149, Münster, Deutschland

    M. Meersch &  A. Zarbock

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  1. M. Meersch
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Correspondence to A. Zarbock.

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M. Meersch und A. Zarbock haben von der Fa. Astute Honorare für Vorträge erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Meersch, M., Zarbock, A. Prävention der akuten Nierenschädigung nach herzchirurgischen Eingriffen. Z Herz- Thorax- Gefäßchir 30, 333–338 (2016). https://doi.org/10.1007/s00398-016-0079-0

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