Remote Ischemic Preconditioning and Contrast-Induced Acute Kidney Injury in Patients Undergoing Elective Percutaneous Coronary Intervention: A Randomized Clinical Trial

Abstract

Background: Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired AKI and a serious complication of percutaneous coronary intervention.

Objective: The aim of the present study was to assess whether remote ischemic preconditioning (RIPC) reduces the incidence of CI-AKI.

Methods: We conducted a prospective, randomized, sham-controlled clinical study. The study included 101 patients admitted to the Intensive Cardiac Therapy Clinic of Medical University of Lodz for elective percutaneous coronary intervention. The participants were randomly assigned in a 1:1 ratio to either a control group (n = 51) or an RIPC group (n = 50). In the latter, RIPC was achieved before percutaneous coronary intervention by 4 cycles of 5-minute inflation of a cuff on the left upper arm to 200 mm Hg followed by 5-minute deflation. In the control group, a deflated cuff was placed on the left arm for 40 minutes. Serum creatinine concentration was measured to check for the presence of CI-AKI within 48 to 72 hours of percutaneous coronary intervention. Serum neutrophil gelatinase-associated lipocalin level was also measured within 3 hours.

Results: CI-AKI occurred in 2 patients from the RIPC group (4%) and 3 patients from the control group (5.9%), but the difference was not significant (P = 0.98). The patients who developed CI-AKI also demonstrated increased serum neutrophil gelatinase-associated lipocalin concentrations (the area under the receiver operator characteristic curve = 0.97; 95% CI, 0.938-1.00; P < 0.00) and the optimal cutoff point value was 118.9 ng/mL.

Conclusions: The use of RIPC before elective percutaneous coronary intervention was not found to prevent CI-AKI. ClinicalTrials.gov identifier: NCT03761368. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX).

Keywords: Contrast-induced acute kidney injury; Coronary angiography; Neutrophil gelatinase-associated lipocalin; Percutaneous coronary intervention; Remote ischemic preconditioning.

© 2020 The Author(s).

Figures

Fig. 1

Flowchart of patients in the study. ITT = intention-to-treat analysis; RIPC = remote ischemic preconditioning.

Fig. 2

Serum neutrophil gelatinase-associated lipocalin (NGAL) concentration changes (difference between value at baseline and 3 hours after percutaneous coronary intervention [PCI]) in remote ischemic preconditioning (RIPC)(+) and RIPC(-) patients.

Fig. 3

Receiver operating characteristic curve and the optimal cutoff point of serum neutrophil gelatinase-associated lipocalin concentration 3 hours after percutaneous coronary intervention (118.9 ng/mL) with respect to the occurrence of contrast-induced acute kidney injury (area under curve = 0.97; sensitivity = 100%, specificity = 91%, and Youden's index = 0.92).

Fig. 4

Serum neutrophil gelatinase-associated lipocalin (NGAL) concentration on admission, as a factor of renal damage, correlates with estimated glomerular filtration rate (eGFR) on admission, as a parameter of impaired renal function (A) and NGAL level 3 hours after percutaneous coronary intervention (PCI) also correlates with eGFR 48 to 72 hours after PCI (B).