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Kidney Week

Abstract: TH-PO053

Remote Ischemic Preconditioning in the Prevention of Contrast Induced Nephropathy in Patients Undergoing Peripheral Angiography: A Pilot Randomized Controlled Trial

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Roy, Debajyoti M., Changi General Hospital, Singapore, Singapore
  • Tang, Tjun Yip, Singapore General Hospital, Singapore, Singapore
  • Aw, Tarchoon, Changi Hospital, Singapore, Singapore
Background

Contrast induced nephropathy (CIN) is a leading cause of hospital acquired acute Kidney injury (AKI). Remote ischemic preconditioning (RIPC) has been found to be protective against AKI in patients undergoing coronary surgery
This project aims to evaluate the potential of RIPC prior to vascular angiography in preventing CIN.

Methods

This study is a single centre,experimental,randomised controlled trial of the effect of RIPC with the induction of brief episodes of upper limb ischemia followed by reperfusion using blood pressure cuffs to determine protection against CIN in advanced periphereal arterial disease undergoing elective angiography. The inclusion criteria for this study are: patients above age of 21 yrs undergoing elective periphereal arterial angiography/angioplasty who have an eGFR> 45ml/min and have given written informed consent.
There are two arms of this trial: Control and preconditioned arm (RIPC). Patients will be randomised 1:1 .
Group 1(Control arm) : IV hydration with 0.9% normal saline (1ml/kg/hour) prior to angiographic procedure
Group 2 (RIPC) : patients will receive IV hydration prior to procedure, similar to control group. Additionally patients will receive RIPC , where a blood pressure cuff will be placed around one arm of the patientand inflated to a pressure of 250mm Hg for 5 minutes, deflated and allow arm to re-perfuse for 5 min.This is repeated for atotal of 3 ischemia-reperfusion cycles.
Patients in both arms had serial measurements of serum creatinine as wellas serum cystatin and urinary NGAL at 2 hours, 24 hours,48 and 72 hours post procedure

Results

There was no signicant differences between Control and RIPC groups with regards baseline characteristics. There was no reduction in development CIN in the RIPC group compared to Control.

Conclusion

RIPC did not offer any protection against development of CIN in our group of patients with eGFR >45ml/min over and above the standard therapy ie. intravenous hydration.
The protective effect of RIPC in patients with more advanced chronic kidney disease needs further study

Table 1.RIPC versus Control