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Remote Ischemic Preconditioning in Renal Protection During Elective Percutaneous Coronary Intervention

  • Małgorzata WojciechowskaEmail author
  • Maciej Zarębiński
  • Piotr Pawluczuk
  • Dagmara Gralak-Łachowska
  • Leszek Pawłowski
  • Wioletta Loska
  • Marzena Goszczyńska
  • Krzysztof Flis
  • Agnieszka Cudnoch-Jędrzejewska
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1116)

Abstract

Remote ischemic preconditioning (RIPC) exerts protection in remote organs. The purpose of this study was to investigate the potential of RIPC to prevent contrast induced nephropathy. One hundred and twenty four patients were randomized to elective percutaneous coronary intervention with or without RIPC. RIPC was performed using three cycles of 5-min inflation to 200 mmHg of a standard upper arm blood pressure cuff. The time between the last inflation cycle and the coronary intervention was less than 2 h. The primary endpoint was the incidence of contrast-induced nephropathy based on the standard criteria of the serum creatinine (SC) and cystatin C (CC) levels. The rates of major cardiac and cerebral adverse events (MACCE) during 1 year follow-up were evaluated. We found that contrast-induced nephropathy assessed by SC occurred in 4.9% (3/61) patients with RIPC and in 12.1% (7/58) patients without it (p = 0.20). Nephropathy assessed by CC occurred in 1.7% (1/58) patients with RIPC and 3.5% (2/57) patients without it (p = 0.62). There was no coincidence between the diagnosis of contrast-induced nephropathy based on SC and CC (McNemar test 0.012, κ = 0.28); SC was a more sensitive marker of nephropathy than CC (ten and three cases, respectively). The MACCE rate during the year of follow-up tended to be lower with the ischemic preconditioning than without it, four vs. six cases, respectively. We conclude that RIPC prior to percutaneous coronary intervention has no major influence on the development of contrast-induced nephropathy and does not improve the one-year outcome.

Keywords

Coronary intervention Kidney insufficiency Nephropathy Percutaneous coronary intervention Remote ischemic preconditioning Renal protection 

Notes

Conflicts of Interest

The author declares no conflicts of interest in relation to this article.

Ethical Approval

All procedures in this study were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration for Human Research and its later amendments.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Małgorzata Wojciechowska
    • 1
    • 2
    Email author
  • Maciej Zarębiński
    • 2
  • Piotr Pawluczuk
    • 2
  • Dagmara Gralak-Łachowska
    • 2
  • Leszek Pawłowski
    • 2
  • Wioletta Loska
    • 2
  • Marzena Goszczyńska
    • 2
  • Krzysztof Flis
    • 2
  • Agnieszka Cudnoch-Jędrzejewska
    • 1
  1. 1.Department of Experimental and Clinical Physiology, Center for Preclinical ResearchWarsaw Medical UniversityWarsawPoland
  2. 2.Invasive Cardiology Unit, Western HospitalGrodzisk MazowieckiPoland

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