Remote ischemic preconditioning has a neutral effect on the incidence of kidney injury after coronary artery bypass graft surgery
| Autor: | Sean Gallagher, Steve M. Harwood, Muhammad M. Yaqoob, Akhil Kapur, Andrew Wragg, Daniel A. Jones, Rohini Mathur, Rakesh Uppal, R. Andrew Archbold |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Renal function urologic and male genital diseases chemistry.chemical_compound Postoperative Complications Troponin T Internal medicine medicine Humans Coronary Artery Bypass Renal Insufficiency Chronic Ischemic Preconditioning Aged Aged 80 and over Creatinine business.industry Acute kidney injury Acute Kidney Injury Middle Aged medicine.disease female genital diseases and pregnancy complications Surgery Cardiac surgery Forearm chemistry Nephrology Reperfusion Injury Cardiology Ischemic preconditioning Female business Reperfusion injury Biomarkers Kidney disease |
| Zdroj: | Kidney International. 87:473-481 |
| ISSN: | 0085-2538 |
| Popis: | Acute kidney injury (AKI) is a frequent complication of cardiac surgery and usually occurs in patients with preexisting chronic kidney disease (CKD). Remote ischemic preconditioning (RIPC) may mitigate the renal ischemia-reperfusion injury associated with cardiac surgery and may be a preventive strategy for postsurgical AKI. We undertook a randomized controlled trial of RIPC to prevent AKI in 86 patients with CKD (estimated glomerular filtration rate under 60 ml/min per 1.73 m(2)) undergoing coronary artery bypass graft (CABG) surgery. Forty-three patients each were randomized to receive standard care with or without RIPC consisting of three 5-minute cycles of forearm ischemia followed by reperfusion. The primary end point was the development of AKI defined as an increase in serum creatinine concentration over 0.3 mg/dl within 48 h of surgery. Secondary end points included a comparison between the study and control groups of several serum biomarkers of renal injury including cystatin-C, neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 (IL-18), and urinary biomarkers including NGAL, IL-18, and kidney injury molecule-1 measured at 6, 12, and 24 h after CABG, and the 72-h serum troponin T concentration area under the curve as a marker of myocardial injury. Clinical and operative characteristics were similar between the preconditioned and control groups. AKI developed in 12 patients in both groups within 48 h of CABG. There were no significant differences between the two groups in the concentrations of any of the serum or urinary biomarkers of renal or cardiac injury after CABG. Thus, RIPC induced by forearm ischemia-reperfusion had no effect on the frequency of AKI after CABG in patients with CKD. |
| Databáze: | OpenAIRE |
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