Remote Ischemic Preconditioning Reduces Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

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Remote Ischemic Preconditioning for Prevention of Acute Kidney Injury: A Meta-analysis of Randomized Controlled Trials

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2014.04.029 ◽

2014 ◽

Vol 64 (4) ◽

pp. 574-583 ◽

Cited By ~ 47

Author(s):

Yi Yang ◽

Xia-bing Lang ◽

Ping Zhang ◽

Rong Lv ◽

Yong-fei Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Randomized Controlled Trials ◽

Ischemic Preconditioning ◽

Meta Analysis ◽

Kidney Injury ◽

Remote Ischemic Preconditioning ◽

Controlled Trials ◽

Randomized Controlled

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Faculty of 1000 evaluation for Does ascorbic acid protect against contrast induced- acute kidney injury in patients undergoing coronary angiography - a systematic review with meta-analysis of randomized controlled trials.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718095571.793485184 ◽

2013 ◽

Author(s):

Mauricio Cohen ◽

Kamalkumar Kolappa

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Ascorbic Acid ◽

Coronary Angiography ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Kidney Injury ◽

Controlled Trials ◽

Randomized Controlled

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Strategies to Prevent Acute Kidney Injury after Pediatric Cardiac Surgery

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.05800421 ◽

2021 ◽

Vol 16 (10) ◽

pp. 1480-1490

Author(s):

Jef Van den Eynde ◽

Nicolas Cloet ◽

Robin Van Lerberghe ◽

Michel Pompeu B.O. Sá ◽

Dirk Vlasselaers ◽

...

Keyword(s):

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Ischemic Preconditioning ◽

Relative Risk Reduction ◽

Meta Analysis ◽

Pediatric Cardiac Surgery ◽

Remote Ischemic Preconditioning ◽

Controlled Trials ◽

Content Type ◽

Randomized Controlled

Background and objectivesAKI is a common complication after pediatric cardiac surgery and has been associated with higher morbidity and mortality. We aimed to compare the efficacy of available pharmacologic and nonpharmacologic strategies to prevent AKI after pediatric cardiac surgery.Design, setting, participants, & measurementsPubMed/MEDLINE, Embase, Cochrane Controlled Trials Register, and reference lists of relevant articles were searched for randomized controlled trials from inception until August 2020. Random effects traditional pairwise, Bayesian network meta-analyses, and trial sequential analyses were performed.ResultsTwenty randomized controlled trials including 2339 patients and 11 preventive strategies met the eligibility criteria. No overall significant differences were observed compared with control for corticosteroids, fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning in traditional pairwise meta-analysis. In contrast, trial sequential analysis suggested a 80% relative risk reduction with dexmedetomidine and evidence of <57% relative risk reduction with remote ischemic preconditioning. Nonetheless, the network meta-analysis was unable to demonstrate any significant differences among the examined treatments, including also acetaminophen, aminophylline, levosimendan, milrinone, and normothermic cardiopulmonary bypass. Surface under the cumulative ranking curve probabilities showed that milrinone (76%) was most likely to result in the lowest risk of AKI, followed by dexmedetomidine (70%), levosimendan (70%), aminophylline (59%), normothermic cardiopulmonary bypass (57%), and remote ischemic preconditioning (55%), although all showing important overlap.ConclusionsCurrent evidence from randomized controlled trials does not support the efficacy of most strategies to prevent AKI in the pediatric population, apart from limited evidence for dexmedetomidine and remote ischemic preconditioning.

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