Using remote ischemic conditioning to reduce acute kidney injury in patients undergoing percutaneous coronary intervention: a meta-analysis

AbstractBackground and aims:It remains uncertain whether remote ischemic conditioning (RIC) could prevent acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI). Thus, this meta-analysis aiming to explore the renoprotective role of RIC in patients undergoing PCI was carried out.Methods:PubMed, Web of Science, and Cochrane Library were searched from inception to 31 December 2014 to identify eligible randomized controlled trials. Pooled risk ratio, mean, standard deviation and 95% CI were used to assess the effect by fixed- or random-effect models. Heterogeneity was assessed by the Cochran Q and I 2 statistics.Results:Nine trials were included in this study. RIC decreased the AKI incidence in patients undergoing PCI compared with control individuals (P < 0.001; RR, 0.53; 95% CI, 0.39–0.71; P for heterogeneity = 0.15; heterogeneity χ2 = 13.38; I2 = 33%). Besides, limb conditioning attenuated AKI (P = 0.001; RR, 0.57; 95% CI, 0.41–0.81; P for heterogeneity = 0.13; heterogeneity χ2 = 12.48; I2 = 36%). Remote postconditioning may reduce the AKI incidence (P = 0.03; RR, 0.65; 95% CI, 0.44–0.97; P for heterogeneity = 0.15; heterogeneity χ2 = 5.36; I2 = 44%); remote preconditioning could also play a renoprotective role (P < 0.001; RR, 0.42; 95% CI, 0.27–0.65; P for heterogeneity = 0.31; heterogeneity χ2 = 5.98; I2 = 16%).Conclusions:RIC may not only confer cardioprotection, but also reduce the incidence of AKI in patients undergoing PCI, ultimately leading to better clinical outcomes. RIC may potentially be a powerful approach conferring protection in patients undergoing PCI in future clinical practice. More large-scale trials are required to obtain a more reliable conclusion.Key words: : Acute kidney injuryComplicationMeta-analysisPercutaneous coronary interventionRemote ischemic conditioning TransparencyDeclaration of fundingThis study was supported by the National Natural Science Foundation of China (81170179).Author contributions: B.Z., F.W. and Z.S. were devoted to the literature search and selection. B.Z. was devoted to statistical analysis and writing for this article. G.W. and M.X. designed this research.Declaration of financial/other relationshipsB.Z., F.W., Z.S., M.X., and G.W. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.