Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Protection of remote ischemic preconditioning against acute kidney injury: a systematic review and meta-analysis

Authors: Jiachang Hu, Shaopeng Liu, Ping Jia, Xialian Xu, Nana Song, Ting Zhang, Rongyi Chen, Xiaoqiang Ding

Published in: Critical Care | Issue 1/2016

Login to get access

Abstract

Background

Remote ischemic preconditioning (RIPC) is a promising approach to preventing acute kidney injury (AKI), but its efficacy is controversial.

Methods

A systematic review of 30 randomized controlled trials was conducted to investigate the effects of RIPC on the incidence and outcomes of AKI. Random effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity. The primary outcome was incidence of AKI and hospital mortality.

Results

The total pooled incidence of AKI in the RIPC group was 11.5 %, significantly less than the 23.3 % incidence in the control group (P = 0.009). Subgroup analyses indicated that RIPC significantly reduced the incidence of AKI in the contrast-induced AKI (CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %, P = 0.173). Random effects meta-regression indicated that RIPC tended to strengthen its renoprotective effect (q = 3.95, df = 1, P = 0.047) in these trials with a higher percentage of diabetes mellitus. RIPC had no significant effect on the incidence of stages 1–3 AKI or renal replacement therapy, change in serum creatinine and estimated glomerular filtration rate (eGFR), hospital or 30-day mortality, or length of hospital stay. But RIPC significantly increased the minimum eGFR in the IR-AKI subgroup (P = 0.006) compared with the control group. In addition, the length of ICU stay in the RIPC group was significantly shorter than in the control group (2.6 vs 2.0 days, P = 0.003).

Conclusions

We found strong evidence to support the application of RIPC to prevent CI-AKI, but not IR-AKI.
Appendix
Available only for authorised users
Literature
1.
2.
Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients [reply]. Nephrol Dial Transplant. 2008;23:4073.CrossRef
3.
Hoste E, Bagshaw S, Bellomo R, Cely C, Colman R, Cruz D, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41:1411–23.CrossRefPubMed
4.
Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol. 2014;9:1148.CrossRef
5.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.CrossRefPubMed
6.
Liaño F, Junco E, Pascual J, Madero R, Verde E, the Madrid Acute Renal Failure Study Group. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. Kidney Int Suppl. 1998;66:S16–24.PubMed
7.
Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983;74:243–8.CrossRefPubMed
8.
9.
10.
Schneider AG, Eastwood GM, Seevanayagam S, Matalanis G, Bellomo R. A risk, injury, failure, loss, and end-stage renal failure score-based trigger for renal replacement therapy and survival after cardiac surgery. J Crit Care. 2012;27:488–95.CrossRefPubMed
11.
Przyklenk K, Whittaker P. Remote ischemic preconditioning: current knowledge, unresolved questions, and future priorities. J Cardiovasc Pharmacol Ther. 2011;16:255–9.CrossRefPubMed
12.
Przyklenk K, Bauer B, Ovize M, Kloner RA, Whittaker P. Regional ischemic ‘preconditioning’ protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation. 1993;87:893–9.CrossRefPubMed
13.
Whittaker P, Przyklenk K. Reduction of infarct size in vivo with ischemic preconditioning: mathematical evidence for protection via non-ischemic tissue. Basic Res Cardiol. 1994;89:6–15.CrossRefPubMed
14.
Wever KE, Menting TP, Rovers M, van der Vliet JA, Rongen GA, Masereeuw R, et al. Ischemic preconditioning in the animal kidney, a systematic review and meta-analysis. PLoS One. 2012;7, e32296.CrossRefPubMedPubMedCentral
15.
Wever KE, Warlé MC, Wagener FADTG, van der Hoorn JW, Masereeuw R, van der Vliet JA, et al. Remote ischaemic preconditioning by brief hind limb ischaemia protects against renal ischaemia-reperfusion injury: the role of adenosine. Nephrol Dial Transplant. 2011;26:3108–17.CrossRefPubMed
16.
Yoon YE, Lee KS, Choi KH, Kim KH, Yang SC, Han WK. Preconditioning strategies for kidney ischemia reperfusion injury: implications of the “time-window” in remote ischemic preconditioning. PLoS One. 2015;10, e0124130.CrossRefPubMedPubMedCentral
17.
Liu T, Fang Y, Liu S, Yu X, Zhang H, Liang M, et al. Limb ischemic preconditioning protects against contrast-induced acute kidney injury in rats via phosphorylation of GSK-3β. Free Radic Biol Med. 2015;81:170–82.CrossRefPubMed
18.
Haji Mohd Yasin NAB. Herbison P, Saxena P, Praporski S, Konstantinov IE. The role of remote ischemic preconditioning in organ protection after cardiac surgery: a meta-analysis. J Surg Res. 2014;186:207–16.CrossRefPubMed
19.
Yang Y, Lang XB, Zhang P, Lv R, Wang YF, Chen JH. Remote ischemic preconditioning for prevention of acute kidney injury: a meta-analysis of randomized controlled trials. Am J Kidney Dis. 2014;64:574–83.CrossRefPubMed
20.
Pinaud F, Corbeau J-J, Baufreton C, Binuani J-P, De Brux J-L, Fouquet O, et al. Remote ischemic preconditioning in aortic valve surgery: Results of a randomized controlled study. J Cardiol. 2016;67:36–41.CrossRefPubMed
21.
Hu Q, Luo W, Huang L, Huang R, Chen R, Gao Y. Multiorgan protection of remote ischemic perconditioning in valve replacement surgery. J Surg Res. 2016;200:13–20.CrossRefPubMed
22.
Zarbock A, Schmidt C, Van Aken H, Wempe C, Martens S, Zahn PK, et al. Effect of Remote Ischemic Preconditioning on Kidney Injury Among High-Risk Patients Undergoing Cardiac Surgery A Randomized Clinical Trial. J Am Med Assoc. 2015;313:2133–41.CrossRef
23.
Yamanaka T, Kawai Y, Miyoshi T, Mima T, Takagaki K, Tsukuda S, et al. Remote ischemic preconditioning reduces contrast-induced acute kidney injury in patients with ST-elevation myocardial infarction: A randomized controlled trial. Int J Cardiol. 2015;178:136–41.CrossRefPubMed
24.
Meybohm P, Bein B, Brosteanu O, Cremer J, Gruenewald M, Stoppe C, et al. A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery. New Engl J Med. 2015;373:1397–407.CrossRefPubMed
25.
Menting TP, Sterenborg TB, de Waal Y, Donders R, Wever KE, Lemson MS, et al. Remote Ischemic Preconditioning To Reduce Contrast-Induced Nephropathy: A Randomized Controlled Trial. Eur J Vasc Endovasc. 2015;50:527–32.CrossRef
26.
Healy DA, Feeley I, Keogh CJ, Scanlon TG, Hodnett PA, Stack AG, et al. Remote ischemic conditioning and renal function after contrast-enhanced CT scan: A randomized trial. Clinl Invest Med Medicine. 2015;38:E110–8.
27.
Hausenloy DJ, Candilio L, Evans R, Ariti C, Jenkins DP, Kolvekar S, et al. Remote Ischemic Preconditioning and Outcomes of Cardiac Surgery. New Engl J Med. 2015;373:1408–17.CrossRefPubMed
28.
Gholoobi A, Sajjadi SM, Shabestari MM, Eshraghi A, Shamloo AS. The Impact of Remote Ischemic Pre-Conditioning on Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography and Angioplasty: A Double-Blind Randomized Clinical Trial. Electron physician. 2015;7:1557–65.CrossRefPubMedPubMedCentral
29.
Gallagher SM, Jones DA, Kapur A, Wragg A, Harwood SM, Mathur R, et al. Remote ischemic preconditioning has a neutral effect on the incidence of kidney injury after coronary artery bypass graft surgery. Kidney Int. 2015;87:473–81.CrossRefPubMed
30.
Candilio L, Malik A, Ariti C, Barnard M, Salvo C, Lawrence D, et al. Effect of remote ischaemic preconditioning on clinical outcomes in patients undergoing cardiac bypass surgery: a randomised controlled clinical trial. Heart. 2015;101:185–92.CrossRefPubMed
31.
Hu J, Chen R, Liu S, Yu X, Zou J, Ding X. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2016;30:82–9.CrossRefPubMed
32.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–12.CrossRefPubMed
33.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.CrossRefPubMed
34.
Mouton R, Pollock J, Soar J, Mitchell D, Rogers C. Remote ischaemic preconditioning for elective abdominal aortic aneurysm (AAA) repair: a randomized controlled trial to assess feasibility [abstract O-29]. Appl Cardiopulm Pathophysiol. 2014;18 Suppl I:35.
35.
Walsh SR, Sadat U, Boyle JR, Tang TY, Lapsley M, Norden AG, et al. Remote ischemic preconditioning for renal protection during elective open infrarenal abdominal aortic aneurysm repair: randomized controlled trial. Vasc Endovascular Surg. 2010;44:334–40.CrossRefPubMed
36.
Ali ZA, Callaghan CJ, Lim E, Ali AA, Nouraei SAR, Akthar AM, et al. Remote ischemic preconditioning reduces myocardial and renal injury after elective abdominal aortic aneurysm repair: a randomized controlled trial. Circulation. 2007;116(11 Suppl):I98–I105.PubMed
37.
Li L, Li G, Yu C, Li Y. The role of remote ischemic preconditioning on postoperative kidney injury in patients undergoing cardiac and vascular interventions: a meta-analysis. J Cardiothorac Surg. 2013;8:43.CrossRefPubMedPubMedCentral
38.
Pei H, Wu Y, Wei Y, Yang Y, Teng S, Zhang H. Remote ischemic preconditioning reduces perioperative cardiac and renal events in patients undergoing elective coronary intervention: a meta-analysis of 11 randomized trials. PLoS One. 2014;9, e115500.CrossRefPubMedPubMedCentral
39.
Moretti C, Cerrato E, Cavallero E, Lin S, Omedè P, Rossi ML, et al. Remote ischemic preconditioning and risk of contrast-induced nephropathy after percutaneous coronary intervention: the Euro-Asia CRIPS randomized controlled trial [abstract C15]. G Ital Cardiol. 2014;15(9 Suppl 1):e4–5.
40.
41.
Oosterlinck W, Dresselaers T, Geldhof V, Nevelsteen I, Janssens S, Himmelreich U, et al. Diabetes mellitus and the metabolic syndrome do not abolish, but might reduce, the cardioprotective effect of ischemic postconditioning. J Thorac Cardiovasc Surg. 2013;145:1595–602.CrossRefPubMed
Metadata
Title
Protection of remote ischemic preconditioning against acute kidney injury: a systematic review and meta-analysis
Authors
Jiachang Hu
Shaopeng Liu
Ping Jia
Xialian Xu
Nana Song
Ting Zhang
Rongyi Chen
Xiaoqiang Ding
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1272-y

Other articles of this Issue 1/2016

Critical Care 1/2016 Go to the issue

Research

The value of blood lactate kinetics in critically ill patients: a systematic review

Research

Long-term outcomes and healthcare utilization following critical illness – a population-based study

Review

Strategies to optimize respiratory muscle function in ICU patients

Research

Association between time of discharge from ICU and hospital mortality: a systematic review and meta-analysis

Research

Association of common genetic variation in the protein C pathway genes with clinical outcomes in acute respiratory distress syndrome

Research

In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan