Effect of Remote Ischemic Preconditioning to Prevent Acute Kidney Injury in Chronic Kidney Disease Patient Undergoing Contrast-enhanced Computed Tomography: A Randomized Controlled Trial

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Pruedtinart Goyadoolya
Pamila Tasanavipas
Narittaya Varothai
Theerasak Tangwonglert
Naowanit Nata
Bancha Stirapoj
Ouppatham Supasyndh

Abstract

Background: Chronic kidney disease (CKD) is an important risk factor of contrast-induced acute kidney injury (CI-AKI). Remote ischemic preconditioning (RIPC); transient ischemia followed by reperfusion of the extremity may subsequently protect against ischemia-induced injury in other organs. A case where RIPC can prevent CI-AKI after contrast-enhanced computed tomography (CT) has not been reported. Method: We conducted a randomized controlled trial in CKD patients, with glomerular infiltration rate (GFR) less than 60 mL/min/1.73m2, whom underwent contrast-enhanced CT during July 2018 to January 2019 at Phramongkutklao Hospital. All patients received standard protocolS to prevent CI-AKI. Patients were allocated in 1:1 ratio to receive RIPC or not (control) by using block of 4 randomization. RIPC consists of 4 cycles of 5 minutes of cuff to induce arm ischemia with 5 minutes of reperfusion before undergoing contrast-enhanced CT. All patients were closely monitored for possible complications. Results: A total of 70 CKD patients (35 in the RIPC group, 35 in the control group) were enrolled. The mean age was 73.6±9.9 years and the baseline GFR was 45.3±12.2 mL/min/1.73m2. Forty-two (60%) patients were male. The incidence of CI-AKI is lower in the RIPC group than the control group (8.57% vs 0%), p-value=0.07. Changes of serum creatinine from the baseline to 48-hour and from 24-hour to 48-hour were better in the RIPC group than those in the control group: -0.09 ±0.16 vs -0.02±0.20 mg/dL, p-value=0.13, and 0.00±0.12 vs 0.08±0.17 mg/dL, p-value = 0.03, respectively. Changes of GFR from 24-hour to 48-hour was also better in the RIPC group than those in the control group; -0.0±5.4 vs -2.4±6.3 mL/min/1.73m2. In the RIPC group, 25 (71.4%) patients had local numbness. Eighteen (51.4%) patients experienced arm pain, with mean pain score 3.1±1.2 of 10, which immediately resolved after the procedure. No serious complication was observed.


Conclusion: RIPC may decrease the risk of CI-AKI in CKD patient undergoing contrast-enhanced CT, without any serious side effect.

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นิพนธ์ต้นฉบับ (Original Article)

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