scholarly journals Is there a protective effect with remote ischemic preconditioning on contrast-induced acute renal injury after coronary angiography in low-risk patients?

2018 ◽  
Vol 8 (4) ◽  
pp. 38-38
Author(s):  
Sanaz Soleymani ◽  
Hamid Reza Samimagham ◽  
Mohammad Tamaddondar ◽  
Hossein Farshidi ◽  
Mahmood Khayatian ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Serum Creatinine ◽  
Protective Effect ◽  
Ischemic Preconditioning ◽  
Low Risk ◽  
Remote Ischemic Preconditioning ◽  
Control Group ◽  
Renal Biomarkers ◽  
Significant Difference ◽  
Risk Patients

Introduction: Contrast-induced acute kidney injury (CIN-AKI) is a serious complication of coronary angiography. Given the weaknesses in the common protective methods used to prevent CIN-AKI, a safe and effective strategy is needed. RIPC has been shown to have a nephroprotective effect. Objectives: We aimed to determine the protective effect of RIPC on CIN-AKI after angiography or percutaneous coronary intervention (PCI) in low-risk patients. Patients and Methods: In our study, 140 low-risk patients who needed angiography or PCI, were assigned to either RIPC or control group. In each group, serum creatinine and urinary neutrophil gelatinaseassociated lipocalin (uNGAL) were measured before the procedure. Serum creatinine was measured daily for 2 days and uNGAL was measured 6 and 24 hours after the procedure. Diagnosis of AKI was, according to the Kidney Disease; Improving Global Outcomes (KDIGO) criteria (2012). Results: The mean age in the remote ischemic preconditioning (RIPC) group was 56.8 ± 11.4 years and 56.3 ± 11.8 years in the control group. We observed no significant difference regarding patient’s characteristic and renal biomarkers at baseline. There was no significant difference in the incidence of AKI (P = 0.116). The uNGAL increased by 36.2% 6-hour after the procedure in patients with AKI, while at the same time, this biomarker increased only by 4.3% in patients without AKI. Conclusion: We concluded that RIPC, with 3 cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease CIN-AKI or altering renal biomarkers course in low-risk patients undergoing coronary angiography or PCI. Additionally, uNGAL, seems to be an appropriate biomarker for early diagnosis of CIN-AKI, 6 hours after contrast media exposure.

scholarly journals The efficiency of remote ischemic preconditioning on serum cystatin C-based acute kidney injury in patients undergoing coronary angiography; a randomized controlled trial

2020 ◽  
Vol 10 (1) ◽  
pp. e09-e09
Author(s):  
Azadeh Moradkhani ◽  
Hamid Reza Samimagham ◽  
Mohammad Tamaddondar ◽  
Hossein Farshidi ◽  
Mahmood Khayatian ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Cystatin C ◽  
Ischemic Preconditioning ◽  
Controlled Trial ◽  
Kidney Injury ◽  
Remote Ischemic Preconditioning ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Significant Difference

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a known complication of cardiac interventions. Remote ischemic preconditioning (RIPC) is a non-pharmacological method which has a nephroprotective effect. Serum cystatin C (CysC) is a suitable biomarker for the early diagnosis of AKI. Objectives: This study aimed to evaluate the incidence of CI-AKI after RIPC in patients undergoing coronary angiography, through assessment of CysC. Patients and Methods: Around 140 patients with stable coronary artery disease undergoing angiography were randomly allocated to two groups of RIPC and control groups. In each group, the following biomarkers were assessed: serum creatinine (Cr) and CysC at baseline, 24-hour and 48-hour serum Cr and 24-hour CysC. The endpoint was the development of AKI based on either the KDIGO criteria or a 15% increase in serum CysC. Results: No significant difference was observed between two groups regarding the incidence of AKI according to either KIDIGO criteria or by the increase of serum CysC (P =0.116 and P =0.392, respectively). Moreover, a 46.99% increase in CysC level was observed among patients with AKI during the first 24 hours after the procedure, while at the same interval, it increased only 16.01% in patients without AKI. Conclusion: RIPC with three cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease serum CysC based CI-AKI or alter renal biomarkers course in patients with low risk, who underwent coronary angiography.

scholarly journals Remote Ischemic Preconditioning Reduces the Risk of Contrast-Induced Nephropathy in Patients with Moderate Renal Impairment Undergoing Percutaneous Coronary Angiography: A Meta-Analysis

2020 ◽  
Vol 45 (4) ◽  
pp. 549-564
Author(s):  
Jin Deng ◽  
Yi Lu ◽  
Jihong Ou ◽  
Xiaofei Shao ◽  
Xin Wang ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Ischemic Preconditioning ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Remote Ischemic Preconditioning ◽  
Controlled Trials ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary

Background/Aims: This meta-analysis evaluated the effects of remote ischemic preconditioning (RIPC) on the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention/coronary angiography (PCI/CA). Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) that assessed the effect of RIPC on CIN in patients undergoing PCI/CA. The main outcomes of interest were the incidence of CIN 48–72 h after CA, the levels of serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin, and estimated glomerular filtration rate (eGFR), mortality, and requirement of hemodialysis and rehospitalization. The analysis was conducted using the random-effect model due to the expected heterogeneity among different studies. Results: In total, 16 trials covering 2,048 patients were identified. By assessing the methodological quality of the included studies through the Coch­rane risk of bias, we found that of the 16 RCTs, 3 had a low risk of bias, 6 a high, and 7 an unclear risk. The application of RIPC decreased the incidence of CIN (relative risk, RR, 0.50, 95% confidence interval, CI, 0.39–0.65; p < 0.001). Subgroup analyses showed that RIPC decreased the incidence of CIN in patients with eGFR <60 mL/min/1.73 m2 (RR 0.53, 95% CI 0.38–0.75; p < 0.001) but not in patients with eGRF ≥60 mL/min/1.73 m2 (RR 0.82, 95% CI 0.35–1.94; p = 0.66) at baseline. Furthermore, the increase in serum creatinine was significantly lower in patients with RIPC compared to control patients (standardized mean difference –1.41, 95% CI –2.46 to –0.35; p = 0.009). Conclusions: Based on 16 RCTs, this meta-analysis shows that RIPC can reduce the risk of CIN in patients with moderate renal impairment undergoing PCI/CA. However, this needs to be confirmed by further high-quality evidence.

scholarly journals The Effect of Remote Ischemic Preconditioning on Serum Creatinine in Patients Undergoing Partial Nephrectomy: A Randomized Controlled Trial

2021 ◽  
Vol 10 (8) ◽  
pp. 1636
Author(s):  
Jaeyeon Chung ◽  
Min Hur ◽  
Hyeyeon Cho ◽  
Jinyoung Bae ◽  
Hyun-Kyu Yoon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Partial Nephrectomy ◽  
Ischemic Preconditioning ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
Control Group ◽  
Significant Difference ◽  
Secondary Outcomes

Renal function declines after partial nephrectomy due to ischemic reperfusion injury induced by surgical insult or renal artery clamping. The effect of remote ischemic preconditioning (RIPC) on reducing renal injury after partial nephrectomy has not been studied regarding urinary biomarkers. Eighty-one patients undergoing partial nephrectomy were randomly assigned to either RIPC or the control group. RIPC protocol consisted of four cycles of five-min inflation and deflation of a blood pressure cuff to 250 mmHg. Serum creatinine levels were compared at the following time points: preoperative baseline, immediate postoperative, on the first and third days after surgery, and two weeks after surgery. The incidence of acute kidney injury, other surgical complication rates, and urinary biomarkers, including urine creatinine, β-2 microglobulin, microalbumin, and N-acetyl-beta-D-glucosaminidase were compared. Split renal functions measured by renal scan were compared up to 18 months after surgery. There was no significant difference in the serum creatinine level on the first postoperative day (median (interquartile range) 0.87 mg/dL (0.72–1.03) in the RIPC group vs. 0.92 mg/dL (0.71–1.12) in the control group, p = 0.728), nor at any other time point. There was no significant difference in the incidence of acute kidney injury. Secondary outcomes, including urinary biomarkers, were not significantly different between the groups. RIPC showed no significant effect on the postoperative serum creatinine level of the first postoperative day. We could not reveal any significant difference in the urinary biomarkers and clinical outcomes. However, further larger randomized trials are required, because our study was not sufficiently powered for the secondary outcomes.

scholarly journals Clinical and prognostic significance of CD34 expression in bone marrow biopsies in myelodysplastic syndrome

2010 ◽  
Vol 63 (7-8) ◽  
pp. 487-491
Author(s):  
Aleksandar Savic ◽  
Nebojsa Rajic ◽  
Nada Vlaisavljevic ◽  
Vesna Cemerikic-Martinovic ◽  
Stevan Popovic
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Statistical Significance ◽  
Prognostic Significance ◽  
Low Risk ◽  
Control Group ◽  
Bone Marrow Biopsies ◽  
Significant Difference ◽  
Risk Patients ◽  
Cd34 Expression

Introduction. The expression of CD34 antigen is increased in a substantial portion of MDS patients, particularly in high risk patients, which was associated with unfavorable survival in some studies. The aim of this study was to determine the CD34 expression in bone marrow biopsies and its prognostic significance in MDS patients and to analyze it in the context of different clinical, laboratory and prognostic parameters. Material and methods. The study was conducted in 53 MDS patients and 20 controls with normal bone marrow. The CD34 expression was determined by CD34 monoclonal antibody and labelled streptovidin biotin peroxidase method. The positivity was determined by counting the 500 cells and it was expressed as percentage. Results. Among the 53 MDS patients there were 37 males and 16 females with average age of 62. The average CD34 expression in the MDS group was 1.37%, the range being 0-8.8%, and in the control group 0.78%, the range being 0-1.60%. The difference was statistically significant (p<0.05). There was a statistically significant difference in the CD34 expression comparing RA and CMML group and high risk and low risk MDS (p<0.02). The median survival in the patients with the CD34 expression with less than 2% was 22 months, while it was 6 months in the patients with the CD34 expression over 2% (p<0.05). In a multivariate analysis the CD34 expression together with the karyotype and transfusion dependence had a statistical significance (p<0.05). Conclusion. The CD34 expression in bone marrow biopsies is higher in the MDS patients comparing with the controls as well as in high risk comparing with low risk patients. The cutoff 2% seems to have a prognostic significance.

Preventive effect of trimetazidine on contrast-induced nephropathy undergoing percutaneous coronary intervention in elderly moderate and high risk diabetics stratified by mehran score

Perfusion ◽  
2020 ◽  
pp. 026765912095205
Author(s):  
Xue Zhang ◽  
Peng Zhang ◽  
Shicheng Yang ◽  
Wenyuan Li ◽  
Xiuzhen Men ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Serum Creatinine ◽  
Coronary Intervention ◽  
Low Risk ◽  
Control Group ◽  
Preventive Effect ◽  
Contrast Induced Nephropathy ◽  
Risk Population ◽  
Percutaneous Coronary

Background: The aim of this research was to use the Mehran risk score to classify elderly diabetics with coronary heart disease to assess the preventive effect of trimetazidine on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in different risk population. Methods: An uncompromised of 760 elderly diabetics that went through PCI were included in this research. The patients were first divided into three groups in the light of MRS: low-risk, moderate-risk, and high-risk group, then randomized into trimetazidine group and the control group respectively. The first endpoint was the amount of CIN, which is described as a rise in serum creatinine levels by ⩾44.2 μmol/L or ⩾25% ratio within 48 or 72 hours after medication. Second endpoint included differences in creatinine clearance rate (CrCl), blood urea nitrogen (BUN), serum creatinine (Scr), cystatin-C (Cys-C), and the incidence of major adverse events after administration. Results: In the three groups, the incidence of CIN in trimetazidine and control group was 5.0% versus 4.9%(χ2 = 0.005, p > 0.05), 8.0% versus 18.0% (χ2 = 7.685, p < 0.05), 10.4% versus 27.1% (χ2 = 4.376, p < 0.05), respectively. The multivariable logistic regression result demonstrated that trimetazidine intervention was a profitable element of CIN in moderate and high-risk groups (OR = 0.294, 95% CI 0.094-0.920, p = 0.035). Conclusion: Our study confirmed that trimetazidine can be considered for preventive treatment of CIN occurrence in elderly diabetics with moderate and high-risk population, while there is no obvious advantage compared with hydration therapy in low-risk patients.

Remote Ischemic Preconditioning Protects Against Endothelial Dysfunction in a Human Model of Systemic Inflammation: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Marco Orlandi ◽  
Stefano Masi ◽  
Devina Bhowruth ◽  
Yago Leira ◽  
Georgios Georgiopoulos ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Endothelial Dysfunction ◽  
Systemic Inflammation ◽  
Ischemic Preconditioning ◽  
Ischemia Reperfusion ◽  
Remote Ischemic Preconditioning ◽  
Human Model ◽  
Control Group ◽  
Flow Mediated Dilatation ◽  
And Oxidative Stress

Objective: Inflammation, oxidative stress, and endothelial dysfunction are known to contribute to ischemia-reperfusion injury. Remote ischemic preconditioning (RIPC) protects from endothelial dysfunction and the damage induced by ischemia-reperfusion. Using intensive periodontal treatment (IPT), an established human model of acute systemic inflammation, we investigated whether RIPC prevents endothelial dysfunction and modulates systemic levels of inflammation and oxidative stress. Approach and Results: Forty-nine participants with periodontitis were randomly allocated to receive either 3 cycles of ischemia-reperfusion on the upper limb (N=25, RIPC) or a sham procedure (N=24, control) before IPT. Endothelial function assessed by flow-mediated dilatation of the brachial artery, inflammatory cytokines, markers of vascular injury, and oxidative stress were evaluated at baseline, day 1, and day 7 after IPT. Twenty-four hours post-IPT, the RIPC group had lower levels of IL (interleukin)-10 and IL-12 compared with the control group ( P <0.05). RIPC attenuated the IPT-induced increase in IL-1β, E-selectin, sICAM-3 (soluble intercellular adhesion molecule 3), and s-thrombomodulin levels between the baseline and day 1 ( P for interaction <0.1). Conversely, oxidative stress was differentially increased at day1 in the RIPC group compared with the control group ( P for interaction <0.1). This was accompanied by a better flow-mediated dilatation (mean difference 1.75% [95% CI, 0.428–3.07], P =0.011). After 7 days from IPT, most of the inflammatory markers endothelial-dependent and -independent vasodilation were similar between groups. Conclusions: RIPC prevented acute endothelial dysfunction by modulation of inflammation and oxidation processes in patients with periodontitis following exposure to an acute inflammatory stimulus. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03072342.

scholarly journals Effect of Remote Ischemic Preconditioning on Kidney Injury Among High-Risk Patients Undergoing Cardiac Surgery

JAMA ◽  
2015 ◽  
Vol 313 (21) ◽  
pp. 2133 ◽  
Author(s):  
Alexander Zarbock ◽  
Christoph Schmidt ◽  
Hugo Van Aken ◽  
Carola Wempe ◽  
Sven Martens ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Ischemic Preconditioning ◽  
Kidney Injury ◽  
Remote Ischemic Preconditioning ◽  
High Risk Patients ◽  
Risk Patients

Early Oral Switch to Linezolid for Low-risk Patients With Staphylococcus aureus Bloodstream Infections: A Propensity-matched Cohort Study

2018 ◽  
Vol 69 (3) ◽  
pp. 381-387 ◽  
Author(s):  
Rein Willekens ◽  
Mireia Puig-Asensio ◽  
Isabel Ruiz-Camps ◽  
Maria N Larrosa ◽  
Juan J González-López ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Length Of Hospital Stay ◽  
Low Risk ◽  
Significant Difference ◽  
Risk Patients ◽  
Oral Switch

Abstract Background Oral switch to linezolid is a promising alternative to standard parenteral therapy (SPT) in Staphylococcus aureus bacteremia (SAB). Methods We conducted a prospective cohort study of all adult cases of SAB between 2013 and 2017 in a Spanish university hospital. We compared the efficacy, safety, and length of hospital stay of patients receiving SPT and those where SPT was switched to oral linezolid between days 3 and 9 of treatment until completion. We excluded complicated SAB and osteoarticular infections. A k-nearest neighbor algorithm was used for propensity score matching with a 2:1 ratio. Results After propensity score matching, we included 45 patients from the linezolid group and 90 patients from the SPT group. Leading SAB sources were catheter related (49.6%), unknown origin (20.0%), and skin and soft tissue (17.0%). We observed no difference in 90-day relapse between the linezolid group and the SPT group (2.2% vs 4.4% respectively; P = .87). No statistically significant difference was observed in 30-day all-cause mortality between the linezolid group and the SPT group (2.2% vs 13.3%; P = .08). The median length of hospital stay after onset was 8 days in the linezolid group and 19 days in the SPT group (P < .01). No drug-related events leading to discontinuation were noted in the linezolid group. Conclusions Treatment of SAB in selected low-risk patients with an oral switch to linezolid between days 3 and 9 of treatment until completion yielded similar clinical outcomes as SPT, allowing earlier discharge from the hospital.

scholarly journals NEPHROPROTECTIVE EFFECTS OF REMOTE ISCHEMIC PRECONDITIONING IN CORONARY ANGIOGRAPHY

2017 ◽  
Vol 69 (11) ◽  
pp. 111
Author(s):  
Naufal Zagidullin ◽  
Elena Sherbakova ◽  
Alina Dunaeva ◽  
Shamil Zagidullin
Keyword(s):  
Coronary Angiography ◽  
Ischemic Preconditioning ◽  
Remote Ischemic Preconditioning

Intensified Conditioning for Children Undergoing BMT for First Bone Marrow Relapse of Acute Lymphoblastic Leukaemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5169-5169
Author(s):  
John Moppett ◽  
Jerry Hancock ◽  
Christopher J.C. Knechtli ◽  
Anthony Oakhill ◽  
Nicholas J. Goulden
Keyword(s):  
High Risk ◽  
Treatment Failure ◽  
Risk Group ◽  
Control Group ◽  
Childhood All ◽  
High Risk Patients ◽  
Significant Difference ◽  
Risk Patients ◽  
High Level ◽  
Risk Of Treatment

Abstract BMT remains the treatment of choice for early BM relapse of childhood ALL. We reasoned that further intensification of cytoreductive therapy pre-BMT may further improve survival amongst those with the highest risk of treatment failure, early BM relapse (BFM groups S3/4) and high level MRD pre-BMT. A cohort of 32 patients transplanted at a single institution (1996–1999) provided an historical control. 8 high risk patients transplanted 1999–2000 received additional fludarabine cytoreduction therapy at the time of transplant (FLA group). MRD analysis and time to relapse were used in a subsequent cohort of 22 patients (BMT 2000–2002) to allocate those at highest risk of treatment failure to receive a further cytoreductive block, FLX, pre-BMT. Method. All patients were conditioned with cyclophosphamide (60mg/m2 x2) and TBI (14.4 Gy). UD and haplo-BMT were T-cell depleted with Campth-1M in vitro and Campath-1G day -9 to -5 (Control and FLA group), and by Miltenyi CD34+ cell depletion (FLX group). GvHD prophylaxis - CSA + MTX for matched related, CSA for Campath treated grafts and none for Miltenyi grafts. The FLA group received fludarabine 25mg/m2 from d −12 to d −10. Patients with on treatment relapse (S4) or high level MRD pre-BMT (MRD++) in the FLX group received DaunoXome 100mg/m2, fludarabine 30mg/m2 x 5d and cytosine 2g/m2 x 5d 3 weeks prior to BMT. Patients and donors. Control group: 28 precursor-B ALL 4 T-ALL; donors - 7 matched related, 13 matched unrelated (MUD) and 12 mismatched unrelated (MMUD); 14 S2, 18 S3/4. FLA group: 5 presursor-B ALL and 3 T-ALL; donors - 2 SIB, 4 MUD, 1 MMUD and 2 haplo; all S4. FLX group: 21 precursor-B and 1 T-ALL; donors - 6 SIB, 7 MUD, 5 MMUD and 4 haplo;13 S2, 9 S4. 7 patients received FLX intensified conditioning (6 S4, 5 high level MRD ++). 3 high risk patients violated protocol and did not receive FLX (1 age &lt;1yr on treatment relapse, 2 S2 MRD ++). Results. Considering those in the high-risk S3/4 group, there was no significant difference in OS between the 3 groups. Survival by study and risk group Study S2 S3/4 Overall Control 10/14 (71%) 3/18 (17%) 13/32 (41%) FLA 2/8 (25%) 2/8 (25%) FLX 11/13 (85%) 3/9 (33%) 14/22 (64%) No excess cardiac events were seen. The TRM is higher in the FLX group than in the control. Outcome data Study TRM Relapse Alive Total Control 3 16 13 32 S2 2 2 10 14 S3/4 1 14 3 18 FLA 3 3 6 12 S2 - - - - S3/4 3 3 3 9 FLX 6 2 14 22 S2 2 0 11 13 S3/4 4 2 3 9 Total 12 21 33 66 2 of 7 patients treated with FLX are in CCR, 2 relapsed and 3 died of TRM. The 3 high risk patients in the FLX study, but who did not receive FLX, are also in CCR. Survival in those in the S2 group (late BM relapse) has been good throughout the study period. Conclusion. In this study the addition of intensive pre-BMT conditioning has not improved survival amongst high risk (S3/4 or MRD ++ pre-BMT) relapses. The number of post-BMT relapses has fallen but this is not clearly related to the use of FLX. The use of more haploidentical donors, more immunosupressive BMT regimes and additional cytoreductive chemotherapy may have contributed to the increased TRM seen. Time and site of relapse remain the clearest predictor of outcome. Further novel strategies are required to improve survival for the S4 risk group. The good OS for children receiving BMT in the S2 group should be noted.

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