Remote Ischemic Conditioning for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions/Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials

J Cardiovasc Pharmacol Ther. 2016 Jan;21(1):53-63. doi: 10.1177/1074248415590197. Epub 2015 Jun 24.

Abstract

Background: It is uncertain whether remote ischemic conditioning (RIC) has a protective effect on contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI)/coronary artery angiography (CAG). We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of RIC on CI-AKI in such patients.

Methods: PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials databases were searched for RCTs that assessed the effect of RIC on CI-AKI in patients undergoing PCI/CAG.

Results: Ten RCTs with 1389 patients (RIC group, 757 and control, 632) were included. The RIC group significantly exerted a lower risk of CI-AKI compared to the controls (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.34-0.77, P = .001), and they had the similar effect on major adverse cardiovascular events within 1 year (OR = 0.36, 95% CI = 0.20-0.66, P < .001). The RIC reduced the rates of death within 30 days, but this was not significant (OR = 0.16, 95% CI = 0.02-1.34, P = .091). The RIC was associated with a significantly lower incidence of CI-AKI in patients following elective PCI/CAG (OR = 0.54, 95% CI = 0.33-0.87, P = .011). The RIC before not after the intervention was effective in reducing the occurrence of CI-AKI (OR: 0.37 vs 1.05, P = .022). The RIC of the upper arm has statistically significant effect on protecting CI-AKI but not that of the lower limb (OR: 0.41 vs 1.41, P = .004). The effect of RIC on CI-AKI was similar between patients with a mean estimated glomerular filtration rate <60 mL/min/1.73 m(2) and those with mean rates ≥60 (OR: 0.23 vs 0.41, P = .333).

Conclusion: The RIC reduced the incidence of CI-AKI in those receiving PCI/CAG. And RIC of the upper arm significantly reduced the risk of CI-AKI but not RIC of the lower limb in patients undergoing PCI/CAG.

Keywords: contrast-induced acute kidney injury; coronary angiography; meta-analysis; percutaneous coronary interventions; remote ischemic conditioning.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / prevention & control*
  • Contrast Media / adverse effects*
  • Coronary Angiography / adverse effects*
  • Humans
  • Incidence
  • Ischemic Preconditioning / methods*
  • Lower Extremity / blood supply*
  • Odds Ratio
  • Percutaneous Coronary Intervention / adverse effects*
  • Protective Factors
  • Randomized Controlled Trials as Topic
  • Regional Blood Flow
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome
  • Upper Extremity / blood supply*

Substances

  • Contrast Media