Peer-Reviewed Journal Details
Mandatory Fields
Healy, DA,Feeley, I,Keogh, CJ,Scanlon, TG,Hodnett, PA,Stack, AG,Moloney, MC,Whittaker, P,Walsh, SR
2015
October
Clinical and investigative medicine. Medecine clinique et experimentale
Remote ischemic conditioning and renal function after contrast-enhanced CT scan: A randomized trial
Published
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Optional Fields
ACUTE KIDNEY INJURY INDUCED NEPHROPATHY CARDIOVASCULAR OUTCOMES ANEURYSM REPAIR PROTECTION DISEASE DYSFUNCTION SURGERY REDUCE RISK
38
110
118
Purpose: Remote ischemic conditioning has been shown to protect against kidney injury in animal and human studies of ischemia-reperfusion. Recent evidence suggests that conditioning may also provide protection against kidney injury caused by contrast medium. The purpose of this study was to determine if conditioning protected against increases in serum creatinine (SCr) after contrast-enhanced computed tomography (CECT).Methods: A randomised controlled trial (NCT 01741896) was performed with institutional review board approval and informed patient consent. Adult in-patients undergoing abdomino-pelvic CECT were allocated to conditioned or control groups. Conditioning consisted of four cycles of five minutes of cuff-induced arm ischemia with three minutes of reperfusion applied similar to 40 minutes before CECT. The primary outcome was SCr change after CECT.Results: Baseline characteristics were similar in both groups. For all patients, conditioning reduced the risk ratio (RR) of increased SCr; RR 0.65 (95% confidence intervals 0.41 to 1.04). The protective effect was greater and the evidence for protection stronger when analysis was restricted to patients with pre-scan reduced renal function (eGFR < 90 mL/min/1.73 m(2)); RR 0.40 (95% confidence intervals 0.17 to 0.95). Logistic regression revealed that conditioning was the only model variable that predicted decreased SCr; odds ratio 0.24 (95% confidence intervals 0.07 to 0.84) in patients with reduced baseline eGFR.Conclusion: Remote conditioning decreased the risk of CECT-associated increases in serum creatinine by 60% in patients with reduced baseline eGFR. Stratification of analysis based on baseline eGFR is warranted because benefit from conditioning will occur only when there is risk of injury.
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