Delayed RIPC for AKI
Trial question
What is the effect of delayed remote ischemic preconditioning in patients at high risk for AKI undergoing cardiac surgery?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
32.0% female
68.0% male
N = 509
509 patients (161 female, 348 male).
Inclusion criteria: patients at high risk for AKI who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass.
Key exclusion criteria: upper extremity PAD; Raynaud's syndrome; end-stage CKD; pre-existing AKI; pregnancy; kidney transplantation.
Interventions
N=254 remote ischemic preconditioning (4 cycles of 5-minute BP cuff inflation to a pressure of 200 mmHg followed by 5-minute cuff deflation).
N=255 sham procedure (sham preconditioning induced by 4 cycles of 5-minute BP cuff inflation to a pressure of 20 mmHg followed by 5-minute cuff deflation).
Primary outcome
Rate of acute kidney injury within 7 days after cardiac surgery
27.2%
35.3%
35.3 %
26.5 %
17.6 %
8.8 %
0.0 %
Remote ischemic
preconditioning
Sham
procedure
Significant
decrease ▼
NNT = 12
Significant decrease in the rate of AKI within 7 days after cardiac surgery (27.2% vs. 35.3%; OR 0.68, 95% CI 0.47 to 1).
Secondary outcomes
No significant difference in median hospital stay (6 days vs. 7 days; AD -1 days, 95% CI -3.03 to 1.03).
No significant difference in stroke at day 90 (1.6% vs. 0.4%; OR 4.06, 95% CI 0.45 to 36.61).
No significant difference in death at day 90 (1.2% vs. 1.2%; OR 1, 95% CI 0.2 to 5.02).
Conclusion
In patients at high risk for AKI who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass, remote ischemic preconditioning was superior to sham procedure with respect to the rate of AKI within 7 days after cardiac surgery.
Reference
Ping Jia #, Qiang Ji #, Zhouping Zou et al. Effect of Delayed Remote Ischemic Preconditioning on Acute Kidney Injury and Outcomes in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial. Circulation. 2024 Sep 25. Online ahead of print.
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