scholarly journals Effect of Combined Treatment of Ketorolac and Remote Ischemic Preconditioning on Renal Ischemia-Reperfusion Injury in Patients Undergoing Partial Nephrectomy: Pilot Study

2018 ◽  
Vol 7 (12) ◽  
pp. 470 ◽  
Author(s):  
Hae Kil ◽  
Ji Kim ◽  
Young Choi ◽  
Hye Lee ◽  
Tae Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Artery ◽  
Partial Nephrectomy ◽  
Ischemic Preconditioning ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Kidney Injury ◽  
Remote Ischemic Preconditioning ◽  
Control Group ◽  
Anesthesia Induction

We evaluated postoperative renal function in patients with/without combined therapy of ketorolac and remote ischemic preconditioning during partial nephrectomy. Sixteen patients were randomly allocated to either the ketorolac combined with RIPC group (KI, n = 8) or control group (n = 8). The KI group received both remote ischemic preconditioning before surgery and intravenous ketorolac of 1 mg/kg before renal artery clamping. Renal parameters were measured before induction, after anesthesia induction, and 2, 12, 24, 48, and 72 h after renal artery declamping. Acute kidney injury was assessed by Acute Kidney Injury Network criteria. The estimated glomerular filtration rate decreased in both groups, but then increased significantly at 48 h and 72 h after declamping only in the KI group compared to 24 h (p = 0.001 and p = 0.016). Additionally, it was higher at 48 h and 72 h after declamping in the KI group compared to the control group (p = 0.025 and p = 0.044). The incidence of acute kidney injury was significantly reduced in the KI group (13%) compared to the control group (83%) (p = 0.026). FENa was markedly increased at 2 h after declamping, and recovered in both groups, but it was more significant at 12 h after declamping in the KI group (p = 0.022). Urinary N-acetyl-1-β-D-glucosoaminidase and serum neutrophil gelatinase-associated lipocalin were similar (p = 0.291 and p = 0.818). There is a possibility that combined therapy of ketorolac and remote ischemic preconditioning prior to ischemia may alleviate renal dysfunction and reduce the incidence of acute kidney injury in patients undergoing partial nephrectomy.

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 Impact of goal-directed hemodynamic management on the incidence of acute kidney injury in patients undergoing partial nephrectomy: a pilot randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qiong-Fang Wu ◽  
Hao Kong ◽  
Zhen-Zhen Xu ◽  
Huai-Jin Li ◽  
Dong-Liang Mu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Partial Nephrectomy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Kidney Injury ◽  
Control Group ◽  
Hemodynamic Management ◽  
Randomized Controlled ◽  
Renal Hilum ◽  
Pilot Randomized Controlled Trial

Abstract Background The incidence of acute kidney injury (AKI) remains high after partial nephrectomy. Ischemia-reperfusion injury produced by renal hilum clamping during surgery might have contributed to the development of AKI. In this study we tested the hypothesis that goal-directed fluid and blood pressure management may reduce AKI in patients following partial nephrectomy. Methods This was a pilot randomized controlled trial. Adult patients who were scheduled to undergo partial nephrectomy were randomized into two groups. In the intervention group, goal-directed hemodynamic management was performed from renal hilum clamping until end of surgery; the target was to maintain stroke volume variation < 6%, cardiac index 3.0–4.0 L/min/m2 and mean arterial pressure > 95 mmHg with crystalloid fluids and infusion of dobutamine and/or norepinephrine. In the control group, hemodynamic management was performed according to routine practice. The primary outcome was the incidence of AKI within the first 3 postoperative days. Results From June 2016 to January 2017, 144 patients were enrolled and randomized (intervention group, n = 72; control group, n = 72). AKI developed in 12.5% of patients in the intervention group and in 20.8% of patients in the control group; the relative reduction of AKI was 39.9% in the intervention group but the difference was not statistically significant (relative risk 0.60, 95% confidence interval [CI] 0.28–1.28; P = 0.180). No significant differences were found regarding AKI classification, change of estimated glomerular filtration rate over time, incidence of postoperative 30-day complications, postoperative length of hospital stay, as well as 30-day and 6-month mortality between the two groups. Conclusion For patients undergoing partial nephrectomy, goal-directed circulatory management during surgery reduced postoperative AKI by about 40%, although not significantly so. The trial was underpowered. Large sample size randomized trials are needed to confirm our results. Trial registration Clinicaltrials.gov identifier: NCT02803372. Date of registration: June 6, 2016.

scholarly journals Remote Ischemic Preconditioning Protects Cisplatin-Induced Acute Kidney Injury through the PTEN/AKT Signaling Pathway

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Wanfen Zhang ◽  
Cheng Chen ◽  
Ran Jing ◽  
Tongqiang Liu ◽  
Bicheng Liu
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Preconditioning ◽  
Therapeutic Strategy ◽  
Molecular Mechanisms ◽  
Kidney Injury ◽  
Akt Signaling ◽  
Remote Ischemic Preconditioning ◽  
Pten Mrna ◽  
Induce Resistance ◽  
In Cis

Although cisplatin (Cis) is an effective chemotherapeutic agent in treatment of various cancers, its adverse effect of nephrotoxicity limits the clinical application. Remote ischemic preconditioning (RIPC) is a strategy to induce resistance in a target organ against the oxidative stress and injury by applying transient, brief episodes of ischemia. However, whether RIPC exerts protective effect on Cis-induced renal injury remains unclear. In this study, we showed that RIPC significantly alleviated the renal functional and histopathological damage of Cis-induced acute kidney injury (AKI) mice. Furthermore, RIPC substantially reversed the downregulation of miR-144 and upregulation of PTEN in renal tissues of Cis-induced AKI mice and alleviated tubular cell apoptosis via activating PTEN/AKT signaling. In mechanism, we demonstrated that miR-144 directly targets the 3’-UTR of PTEN mRNA, and then the elevation of miR-144 in RIPC activates PTEN/AKT signaling by downregulating PTEN expression to achieve its antiapoptosis effect. Collectively, our results indicate that RIPC may be a potential therapeutic strategy in Cis-induced AKI, and provide insights on the underlying molecular mechanisms of cisplatin’s nephrotoxicity.

scholarly journals Delayed Remote Ischemic Preconditioning ConfersRenoprotection against Septic Acute Kidney Injury via Exosomal miR-21

Theranostics ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 405-423 ◽  
Author(s):  
Tianyi Pan ◽  
Ping Jia ◽  
Nan Chen ◽  
Yi Fang ◽  
Yiran Liang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Preconditioning ◽  
Kidney Injury ◽  
Remote Ischemic Preconditioning ◽  
Septic Acute Kidney Injury

Long-term Effects of Remote Ischemic Preconditioning on Kidney Function in High-risk Cardiac Surgery Patients

2017 ◽  
Vol 126 (5) ◽  
pp. 787-798 ◽  
Author(s):  
Alexander Zarbock ◽  
John A. Kellum ◽  
Hugo Van Aken ◽  
Christoph Schmidt ◽  
Mira Küllmar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
High Risk ◽  
Renal Dysfunction ◽  
Ischemic Preconditioning ◽  
Absolute Risk ◽  
Kidney Injury ◽  
Absolute Risk Reduction ◽  
Remote Ischemic Preconditioning ◽  
Major Adverse Kidney Events

Abstract Background In a multicenter, randomized trial, the authors enrolled patients at high-risk for acute kidney injury as identified by a Cleveland Clinic Foundation score of 6 or more. The authors enrolled 240 patients at four hospitals and randomized them to remote ischemic preconditioning or control. The authors found that remote ischemic preconditioning reduced acute kidney injury in high-risk patients undergoing cardiac surgery. The authors now report on the effects of remote ischemic preconditioning on 90-day outcomes. Methods In this follow-up study of the RenalRIP trial, the authors examined the effect of remote ischemic preconditioning on the composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction at 90 days. Secondary outcomes were persistent renal dysfunction and dialysis dependence in patients with acute kidney injury. Results Remote ischemic preconditioning significantly reduced the occurrence of major adverse kidney events at 90 days (17 of 120 [14.2%]) versus control (30 of 120 [25.0%]; absolute risk reduction, 10.8%; 95% CI, 0.9 to 20.8%; P = 0.034). In those patients who developed acute kidney injury after cardiac surgery, 2 of 38 subjects in the remote ischemic preconditioning group (5.3%) and 13 of 56 subjects in the control group (23.2%) failed to recover renal function at 90 days (absolute risk reduction, 17.9%; 95% CI, 4.8 to 31.1%; P = 0.020). Acute kidney injury biomarkers were also increased in patients reaching the major adverse kidney event endpoint compared to patients who did not. Conclusions Remote ischemic preconditioning significantly reduced the 3-month incidence of a composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction in high-risk patients undergoing cardiac surgery. Furthermore, remote ischemic preconditioning enhanced renal recovery in patients with acute kidney injury.

scholarly journals A Randomized Controlled Study of Remote Ischemic Preconditioning for Prevention of Contrast-Induced Nephropathy

2019 ◽  
Vol 12 (1) ◽  
pp. 72-76
Author(s):  
Krishnaswamy Sampathkumar ◽  
Ratchagan Saravanan
Keyword(s):  
Ischemic Preconditioning ◽  
Simple Procedure ◽  
Kidney Injury ◽  
Remote Ischemic Preconditioning ◽  
Controlled Study ◽  
Control Group ◽  
Open Label ◽  
Group 4 ◽  
Intravenous Saline ◽  
Contrast Exposure

Introduction: Remote Ischemic Preconditioning (RIPC) is a technique which applies brief periods of reversible ischemia and reperfusion to limbs provoking adaptive protective responses to distant organs like Heart, Kidneys and Brain. Methods: Its efficacy in the prevention of Contrast Nephropathy was tested in our open-label, randomized and sham- controlled study. 100 patients with Chronic Kidney Disease Stages 1-3a requiring Contrast agent for Percutaneous Coronary Interventions were included. Subjects were randomized in a 1:1 ratio to receive either Remote Ischemic Preconditioning (RIPC) or sham preconditioning. Results & Discussion: Both groups were treated with Intravenous saline therapy before contrast exposure. The primary end point was contrast-Induced AKI. Baseline characteristics were comparable in both groups. Mean GFR in ml/min was similar in both groups (RIPC 54.8+/- 9 ml/min; Control 54.8+/- 9 ml/min) . Contrast-induced AKI occurred in 19/50 patients in control group and 6/50 in IPC group (p = 0.005).Hemodialysis was required only in control group (4/50) (p = 0.058). 30 day rehospitalization was more in control group (8 / 50) than RIPC group (1/50) (p = 0.01). RIPC was well- tolerated without adverse effects. Conclusion: In conclusion, remote ischemic preconditioning applied before contrast exposure prevents contrast-induced acute kidney injury in CKD 3a. This simple procedure can be added to intravenous saline therapy for nephroprotection.

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 Pengaruh Remote Ischemic Preconditioning Terhadap Angka Kejadian Aritmia dan Acute Kidney Injury Pada Pasien Dewasa Pasca Operasi Bedah Jantung

2016 ◽  
Vol 8 (2) ◽  
pp. 122
Author(s):  
Dedy Fachrian ◽  
Mohamad Sofyan Harahap
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Preconditioning ◽  
Kidney Injury ◽  
Drop Out ◽  
Remote Ischemic Preconditioning

Latar Belakang : Cedera reperfusi (IRI) akibat klem aorta saat operasi jantung mengakibatkan kematian kardiomiosit, gangguan fungsi kontraktilitas jantung, aritmia, dan kematian. Penggunaan CPB juga memicu terjadinya acute kidney injury (AKI) yang prevalensinya mencapai 30%. Salah satu pencegahannya adalah mempersiapkan miokardium terhadap efek buruk dari klem aorta. Mempersiapkan (preconditioning) miokardium ini pada dasarnya adalah untuk meningkatkan stimulasi dari mekanisme kardioprotektif bawaan melalui tindakan pemberian iskemia yang tidak mematikan secara periodik. Pemberian iskemik pada otot rangka lengan atau tungkai dengan menggunakan manset bertekanan secara periodik dan durasi yang singkat dapat memberikan proteksi pada miokardium dan ginjal dari IRI. Hal ini diharapkan dapat mencegah aritmia dan AKI setelah operasi jantung.Tujuan : Mengetahui apakah RIPC dapat mencegah aritmia dan Acute Kidney Injury (AKI) pada pasien setelah operasi bedah jantung dengan klem aorta dan menggunaan mesin CPB.Metode : Penelitian ini merupakan jenis uji klinis acak terkontrol. Sampel sebanyak 30 pasien yeng terbagi menjadi 2 kelompok yaitu kelompok kontrol (K) 15 subjek dan perlakuan (P) 15 subjek. Kelompok perlakuan setelah dilakukan induksi anestesi dan sebelum dilakukan sternotomi akan diberikan prosedur RIPC yaitu dengan melakukan pengembangan manset pada salah satu lengan atas sampai 200 mmHg dan dipertahankan selama 5 menit kemudian manset di kempiskan dan hal ini dipertahankan sampai 5 menit. Siklus ini kemudian diulangi lagi sehingga lama prosedur ini memakan waktu selama 20 menit. Sedangkan pada kelompok kontrol manset dipasang pada salah satu lengan atas subjek dan dibiarkan tidak dikembangkan selama 20 menit. Selama operasi lama tindakan ligasi aorta diukur dan jika lama ligasi aorta lebih dari 20 menit maka penelitian dilanjutkan tetapi jika lama ligasi aorta kurang dari 20 menit maka subjek penelitian di drop out dari penelitian. Setelah dilakukan pembukaan ligasi aorta, pemantauan akan adanya aritmia dimulai sampai 24 jam kedepan. Setelah operasi selesai dan pasien di transfer ke ICU, pada perawatan jam ke 12, 24, 36, 48, 60 dan 72 jam perawatan dilakukan pemantauan produksi urine dan pengambilan sampel darah dan diperiksa kadar serum kreatinin.Hasil : Aritmia didapatkan pada 11 subjek kontrol dan 2 subjek perlakuan dengan Atrial Fibrilasi merupakan jenis aritmia yang paling banyak didapatkan yaitu 9 subjek pada kontrol dan 1 subjek pada perlakuan. AKI didapatkan pada 11 subjek kontrol dan 1 subjek perlakuan. Pada uji Mann-Whitney didapatkan penurunan angka kejadian aritmia pada kelompok perlakuan yang berbeda bermakna (p=0,01) serta penurunan angka kejadian AKI pada kelompok perlakuan yang berbeda bermakna (p=0,04).Kesimpulan : Tindakan RIPC dengan 2 siklus iskemia dan reperfusi pada kelompok perlakuan terbukti menurunkan angka kejadian aritmia dan AKI pasca operasi jantung secara bermakna dibanding kelompok kontrol.

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