Abstract: FR-PO082
Effect of Remote Ischemic Preconditioning to Prevent AKI in CKD Patients Undergoing Contrast-Enhanced Computed Tomography: A Randomized Controlled Trial
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Goyadoolya, Pruedtinart, Phramongkutklao Hospital, Bangkok, Thailand
- Satirapoj, Bancha, Phramongkutklao Hospital, Bangkok, Thailand
- Tasanavipas, Pamila, Phramongkutklao Hospital, Bangkok, Thailand
- Varothai, Narittaya, Phramongkutklao Hospital, Bangkok, Thailand
- Tangwonglert, Theerasak, Phramongkutklao Hospital, Bangkok, Thailand
- Nata, Naowanit, Phramongkutklao Hospital, Bangkok, Thailand
- Supasyndh, Ouppatham, Phramongkutklao Hospital, Bangkok, Thailand
- Chaiprasert, Amnart, Phramongkutklao Hospital, Bangkok, Thailand
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 the other organs. Whether RIPC can prevent CI-AKI after contrast-enhanced computed tomography (CT) is not known.
Methods
We conducted a randomized controlled trial in CKD patients, 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 protocol to prevent CI-AKI. Patients were allocated in 1:1 ratio to receive RIPC or not (control) by using block of 4 randomization.RIPC consistsof 4 cycles of 5 minutes of cuff to induce arm ischemia with 5 minutes of reperfusionbefore 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. Mean age was 73.6±9.9 years and 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 RIPCgroup than the control group (8.57% vs 0%), p-value=0.07. Changes of serum creatinine from baseline to 48-hour and from 24-hour to 48-hour were better in the RIPC group than 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. Change of GFR from 24-hour to 48-hour was also better in the RIPC group than 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 armpain, mean pain score 3.1±1.2 out 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.