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Kidney Week

Abstract: TH-PO054

The Effect of Remote Ischemic Preconditioning for Preventing Contrast-Induced AKI in CKD Patients Undergoing Elective Coronary Angiography

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Tusnapituk, Tatiporn, Police general hospital, Bangkok, Thailand
  • Chirananthavat, Thanit, Police General Hospital, Nonthaburi, Thailand
Background

Despite the increasing use of pre- and post-hydration protocols and low-osmolar contrast media, the incidence of Contrast-Induced Acute Kidney Injury (CI-AKI) is still significant. The underlying mechanism has been attributed in part to ischemic kidney injury. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low-cost method to reduce ischemic reperfusion injury. We aim to investigate whether RIPC, as an adjunct to standard preventive measures, reduces CI-AKI in chronic kidney disease (CKD) patients who are in high risk of CI-AKI.

Methods

This randomized double-blind control trial compared standard care with or without ischemic preconditioning (4 cycles of intermittent arm ischemia) in patients with impaired renal function (estimated glomerular filtration rate, eGFR < 60 mL /min/1.73 m2 by CKD-EPI equation) undergoing elective coronary angiography in the Police General Hospital between May 2017 and February 2018. The primary outcome was the incidence of CI-AKI, defined as an increase in serum creatinine > 0.3 mg/dL or 1.5 times above baseline at 48 hours after contrast medium exposure.

Results

A total of 50 patients, 55 episodes were enrolled, out of which 28 were in the RIPC group, and 27 were in the control group. The medians of contrast media volume, serum creatinine, and eGFR at baseline did not differ between the groups. The primary outcome, CI-AKI, occurred in a total of 7 episodes, consisting of 2 (7%) in the RIPC group and 5 (18%) in the control group, with no significant difference between the two groups (p=0.21).

Conclusion

RIPC cannot reduce the incidence of CI-AKI after contrast administration in CKD patients who are at risk of CI-AKI.