Remote ischemic preconditioning for prevention of contrast-associated acute kidney injury following percutaneous coronary intervention: a randomized controlled trial

ABSTRACT Background Contrast-associated acute kidney injury (CA-AKI) has been reported to occur in a significant proportion of patients undergoing percutaneous coronary intervention (PCI). The role of remote ischemic preconditioning (RIPC) in CA-AKI prevention remains unclear. Methods In this single-center double-blind randomized controlled trial, 420 eligible patients with high risk of CA-AKI admitted for PCI were randomized into two groups: RIPC and sham RIPC (control group). RIPC was performed by repeated cycles of inflation and deflation of an upper limb blood pressure cuff prior to PCI. Serum neutrophil gelatinase-associated lipocalin (NGAL) levels were measured at 2- and 6-h, and serum creatinine at 24- and 48-h post-PCI. The primary endpoint was the incidence of CA-AKI. Secondary endpoints were change in serum creatinine at 48 h, incidence of subclinical AKI (defined as an increase in NGAL values by 25% or more from baseline), change in NGAL at 2- and 6-h (delta NGAL), in-hospital mortality and major adverse cardiovascular events (MACE) at Day 30. Results CA-AKI occurred in 11.4% (n = 48), with AKI stage 1 in 10.2% (n = 42). The incidence of CA-AKI was significantly lower in the RIPC group, compared with control group [8.1% vs 15.0%, risk ratio (RR) 0.54, 95% confidence interval (CI) 0.31–0.94; P = .027]. There was no significant difference in change in creatinine at 48 h in both the groups (P = .158). The incidence of subclinical AKI was also numerically lower in the RIPC group; however, this was not statistically significant (36.2% vs 40.5%, RR 0.89, 95% CI 0.66–1.22; P = .158). Dialysis-requiring AKI, in-hospital mortality and 30-day MACE were similar in both groups. There were no RIPC-related adverse events. Conclusions In patients at high risk of developing CA-AKI after PCI, RIPC is an effective and safe preventive measure.