远程缺血预处理对高危心脏手术患者肾功能的长期影响：RenalRIP 试验的随访结果。
Long-term Effects of Remote Ischemic Preconditioning on Kidney Function in High-risk Cardiac Surgery Patients: Follow-up Results from the RenalRIP Trial.
机构信息
From the Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine (A.Z., H.V.A., C.S., M.K., M.M.) and Department of Cardiac Surgery (S.M.), University Hospital Münster, Münster, Germany; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (J.A.K.); Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany (P.R.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (D.G.).
出版信息
Anesthesiology. 2017 May;126(5):787-798. doi: 10.1097/ALN.0000000000001598.
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.
背景
在一项多中心、随机试验中，作者招募了克利夫兰诊所基金会评分≥6 分的急性肾损伤高危患者。作者在四家医院招募了 240 名患者，并将他们随机分为远程缺血预处理组或对照组。作者发现远程缺血预处理可降低接受心脏手术的高危患者的急性肾损伤发生率。作者现报告远程缺血预处理对 90 天结局的影响。
方法
在 RenalRIP 试验的这项随访研究中，作者检查了远程缺血预处理对主要不良肾脏事件复合终点（包括 90 天死亡、需要肾脏替代治疗和持续肾功能障碍）的影响。次要结局为急性肾损伤患者的持续肾功能障碍和透析依赖。
结果
与对照组（120 例中的 30 例[25.0%]）相比，远程缺血预处理组在 90 天时主要不良肾脏事件的发生率显著降低（120 例中的 17 例[14.2%]）（绝对风险降低，10.8%；95%CI，0.9 至 20.8%；P=0.034）。在接受心脏手术后发生急性肾损伤的患者中，远程缺血预处理组有 2 例（5.3%）和对照组有 13 例（56 例中的 23.2%）未能在 90 天内恢复肾功能（绝对风险降低，17.9%；95%CI，4.8 至 31.1%；P=0.020）。与未达到主要不良肾脏事件终点的患者相比，达到该终点的患者的急性肾损伤生物标志物也有所增加。
结论
远程缺血预处理可显著降低高危心脏手术患者的 3 个月复合主要不良肾脏事件（包括死亡率、需要肾脏替代治疗和持续肾功能障碍）发生率。此外，远程缺血预处理可增强急性肾损伤患者的肾脏恢复。
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