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Vol.3 - No.3

Effect of remote ischemic preconditioning on renal dysfunction after complex valvularheart surgery: A randomized controlled trial

By : baghaei

Keywords : -

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Objectives

Acute kidney injury after cardiac surgery with cardiopulmonary
bypass is closely related to systemic inflammatory
reactions and oxidative stresses. Remote ischemic preconditioning
is a systemic protective strategy whereby brief
limb ischemia confers systemic protection against prolonged
ischemia and inflammatory reactions in distant organs. This
study investigated whether remote ischemic preconditioning
provides systemic protective effect on kidneys that are not
directly exposed to ischemia-reperfusion injury during complex
valvular heart surgery.

Methods

Seventy-six adult patients undergoing complex valvular
heart surgery were randomly assigned to either remote
ischemic preconditioning group (n = 38) or control group
(n = 38). Remote ischemic preconditioning consisted of 3 10-
minute cycles of lower limb ischemia and reperfusion with
an automated cuff inflator. Primary end points were comparisonsof biomarkers of renal injury including serum creatinine,
cystatin C and neutrophil gelatinase-associated lipocalin, and
incidence of acute kidney injury. Secondary end points were
comparisons of myocardial enzyme release and pulmonary
parameters.

Results

There were no significant differences in serum levels
of biomarkers of renal injury between groups throughout
the study period. The incidence of acute kidney injury did not
differ between groups. Creatine kinase isoenzyme MB at 24
hours after surgery was lower, and intensive care unit stay was
shorter in the remote ischemic preconditioning group than in
the control group.

Conclusion

In patients undergoing complex valvular heart
surgery, remote ischemic preconditioning did not reduce degree
of renal injury or incidence of acute kidney injury whereas
it did reduce myocardial injury and intensive care unit stay.

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