#3384 Effect of remote ischemic preconditioning on hemodialysis adequacy, hematological, and cardiovascular parameters in hemodialysis patients: a randomized controlled trial

Abstract Background and Aims Remote ischemic preconditioning (RIPC), characterized by transient cycles of ischemia-reperfusion, has demonstrated organ-protective effects against ischemic injury. Hemodialysis (HD) is associated with microcirculatory disturbances, endothelial dysfunction, oxidative stress, and systemic inflammation, which may exacerbate tissue ischemia. This study aimed to evaluate the impact of RIPC on dialysis adequacy, hematological parameters, and cardiovascular outcomes in HD patients. Method In this single-blind randomized controlled trial, 55 patients on maintenance HD (>1 year) were allocated to an intervention group (n = 30) receiving RIPC (three cycles of 5-minute ischemia at 200 mmHg via sphygmomanometer cuff on the non-access arm, followed by 5-minute reperfusion) prior to each HD session for 12 weeks, or a control group (n = 25). Dialysis adequacy was assessed via single-pool Kt/V and urea reduction ratio (URR). Hematological parameters (hemoglobin, hematocrit, neutrophil-lymphocyte ratio) and cardiovascular metrics (trans-thoracic echocardiography) were evaluated Results Baseline demographics (age: 41 ± 10 vs. 36 ± 12 years; sex, dialysis vintage) were comparable between groups (P > 0.05). Post-intervention, intragroup analysis revealed a significant increase in Kt/V within the RIPC group (1.24 ± 0.23 to 1.36 ± 0.23, P = 0.04), though between-group differences in Kt/V (P = 0.6) and URR (P = 0.5) were nonsignificant. Hemoglobin levels were higher in the RIPC group versus controls (11.7 ± 1.2 vs. 11.1 ± 1.0 g/dL, P < 0.05), with no significant changes in hematocrit, platelets, or inflammatory markers. Echocardiography demonstrated a reduction in intraventricular septal diameter post-HD in the RIPC group (1.39 ± 0.34 to 1.17 ± 0.30 cm) versus controls (1.33 ± 0.29 to 1.32 ± 0.26 cm; P = 0.01), suggesting cardioprotective effects. Conclusion RIPC may offer potential benefits in anemia management and cardiovascular remodeling in HD patients, though its impact on dialysis adequacy remains inconclusive. These findings warrant further investigation into RIPC as an adjunctive therapy to mitigate HD-associated complications.