REMOTE ISCHEMIC PRECONDITIONING, A NOVEL RENOPROTECTIVE STRATEGY AGAINST CONTRAST INDUCED ACUTE KIDNEY INJURY

Abstract

Objective: To compare contrast induced Acute Kidney Injury amongst patientswith stable angina, unstable angina and Non ST elevation myocardial infarctionundergoing elective Coronary angiography and or percutaneous coronaryintervention with versus without applying Remote Ischemia Preconditioning. Methodology: It is a randomized control trial conducted at The Aga KhanUniversity Hospital, Karachi, from January, 2015 till June, 2015.Patients agedÝ30 years, having baseline serum creatinine level Ý 1.4mg/dl with the abovementioned conditions who were to undergo coronary angiography and orpercutaneous coronary intervention were randomly assigned to one of eitherintervention group or control group. All patients received standard care followedby application of RIPC to the intervention arm only. Baseline characteristics of allpatients were recorded and they were followed for 48 hours. The data wasanalyzed using STATA version 12.0. Results: Out of 103 patients, 53 were in Intervention arm and 50 in Control armwith an average age 65 and 66 years respectively. Majority were male in both thegroups. The primary outcome (Contrast Induced Nephropathy) was significantlylower in the intervention arm vs control arm (3.7% vs14%). Multivariable logisticregression analysis suggested a protective effect of the intervention (RIPC) withadjusted Odd Ratio of 0.07 (95% CI: 0.007-0.72, p-value: 0.026) Patients withprior MI were at higher risk for CI-AKI. Conclusion: Remote Ischemic Preconditioning has a significantly higher renalprotective role against Contrast Induced Nephropathy. Key Words: Remote ischemic preconditioning; Contrast induced acute kidneyinjury; Coronary angiography; Percutaneous coronary intervention; Acute renalfailure; Biochemical messengers, Oxidative stress