Department of Internal Medicine III, University of Cologne, Germany.
Circulation. 2012 Jul 17;126(3):296-303. doi: 10.1161/CIRCULATIONAHA.112.096370. Epub 2012 Jun 26.
Contrast medium-induced acute kidney injury is associated with substantial morbidity and mortality. The underlying mechanism has been attributed in part to ischemic kidney injury. The aim of this randomized, double-blind, sham-controlled trial was to assess the impact of remote ischemic preconditioning on contrast medium-induced acute kidney injury.
Patients with impaired renal function (serum creatinine >1.4 mg/dL or estimated glomerular filtration rate <60 mL · min(-1) · 1.73 m(-2)) undergoing elective coronary angiography were randomized in a 1:1 ratio to standard care with (n=50) or without ischemic preconditioning (n=50; intermittent arm ischemia through 4 cycles of 5-minute inflation and 5-minute deflation of a blood pressure cuff). Overall, both study groups were at high risk of developing contrast medium-induced acute kidney injury according to the Mehran risk score. The primary end point was the incidence of contrast medium-induced kidney injury, defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dL above baseline at 48 hours after contrast medium exposure. Contrast medium-induced acute kidney injury occurred in 26 patients (26%), 20 (40%) in the control group and 6 (12%) in the remote ischemic preconditioning group (odds ratio, 0.21; 95% confidence interval, 0.07-0.57; P=0.002). No major adverse events were related to remote ischemic preconditioning.
Remote ischemic preconditioning before contrast medium use prevents contrast medium-induced acute kidney injury in high-risk patients. Our findings merit a larger trial to establish the effect of remote ischemic preconditioning on clinical outcomes.
URL: http://www.germanctr.de. Unique identifier: U1111-1118-8098.
对比剂诱导的急性肾损伤与大量发病率和死亡率相关。其潜在机制部分归因于缺血性肾损伤。本随机、双盲、假对照试验旨在评估远程缺血预处理对对比剂诱导的急性肾损伤的影响。
肾功能受损（血清肌酐 >1.4mg/dL 或估计肾小球滤过率 <60mL·min(-1)·1.73m(-2)）行择期冠状动脉造影的患者按 1:1 比例随机分为标准治疗组（n=50）或缺血预处理组（n=50；通过血压袖带充气和放气 4 个循环，间歇性手臂缺血）。根据 Mehran 风险评分，两组患者均发生对比剂诱导的急性肾损伤的风险较高。主要终点是对比剂诱导的肾损伤的发生率，定义为在造影剂暴露后 48 小时血清肌酐较基线增加≥25%或≥0.5mg/dL。26 例（26%）患者发生对比剂诱导的急性肾损伤，对照组 20 例（40%），远程缺血预处理组 6 例（12%）（比值比，0.21；95%置信区间，0.07-0.57；P=0.002）。远程缺血预处理与主要不良事件无关。
在使用造影剂前进行远程缺血预处理可预防高危患者的对比剂诱导的急性肾损伤。我们的研究结果值得进行更大规模的试验，以确定远程缺血预处理对临床结局的影响。
