Limits...
Protection of remote ischemic preconditioning against acute kidney injury: a systematic review and meta-analysis.

Hu J, Liu S, Jia P, Xu X, Song N, Zhang T, Chen R, Ding X - Crit Care (2016)

Bottom Line: Subgroup analyses indicated that RIPC significantly reduced the incidence of AKI in the contrast-induced AKI (CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %, P = 0.173).In addition, the length of ICU stay in the RIPC group was significantly shorter than in the control group (2.6 vs 2.0 days, P = 0.003).We found strong evidence to support the application of RIPC to prevent CI-AKI, but not IR-AKI.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.

ABSTRACT

Background: Remote ischemic preconditioning (RIPC) is a promising approach to preventing acute kidney injury (AKI), but its efficacy is controversial.

Methods: A systematic review of 30 randomized controlled trials was conducted to investigate the effects of RIPC on the incidence and outcomes of AKI. Random effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity. The primary outcome was incidence of AKI and hospital mortality.

Results: The total pooled incidence of AKI in the RIPC group was 11.5 %, significantly less than the 23.3 % incidence in the control group (P = 0.009). Subgroup analyses indicated that RIPC significantly reduced the incidence of AKI in the contrast-induced AKI (CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %, P = 0.173). Random effects meta-regression indicated that RIPC tended to strengthen its renoprotective effect (q = 3.95, df = 1, P = 0.047) in these trials with a higher percentage of diabetes mellitus. RIPC had no significant effect on the incidence of stages 1-3 AKI or renal replacement therapy, change in serum creatinine and estimated glomerular filtration rate (eGFR), hospital or 30-day mortality, or length of hospital stay. But RIPC significantly increased the minimum eGFR in the IR-AKI subgroup (P = 0.006) compared with the control group. In addition, the length of ICU stay in the RIPC group was significantly shorter than in the control group (2.6 vs 2.0 days, P = 0.003).

Conclusions: We found strong evidence to support the application of RIPC to prevent CI-AKI, but not IR-AKI.

No MeSH data available.


Related in: MedlinePlus

Effects of remote ischemic preconditioning (RIPC) on the incidence of acute kidney injury (AKI). (a) Effects of RIPC on total AKI, ischemia/reperfusion-induced AKI (IR-AKI) and contrast-induced AKI (CI-AKI). (b) Effects of RIPC on every stage of AKI. **P < 0.01
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4837562&req=5

Fig2: Effects of remote ischemic preconditioning (RIPC) on the incidence of acute kidney injury (AKI). (a) Effects of RIPC on total AKI, ischemia/reperfusion-induced AKI (IR-AKI) and contrast-induced AKI (CI-AKI). (b) Effects of RIPC on every stage of AKI. **P < 0.01

Mentions: Data regarding the incidence of AKI were available in 26 trials with an aggregated 7009 patients. The total pooled incidence of AKI in the RIPC group was 11.5 % (95 % CI 8.5–15.3), which was significantly lower than the 23.3 % (95 % CI 16.6–31.8) in the control group (RR 0.834, 95 % CI 0.728–0.955, P = 0.009). Nine studies with an aggregated 2504 patients after cardiac surgery provided the incidence in every stage of AKI. The pooled incidence rates were 17.5 % (95 % CI 11.6–25.5), 7.9 % (95 % CI 4.1–14.7), and 4.2 % (95 % CI 2.3–7.2) for stage 1, stage 2, and stage 3 AKI, respectively, in the RIPC group. The corresponding rates were 26.8 % (95 % CI 21.7–32.4), 9.4 % (95 % CI 5.7–15.3), and 4.8 % (95 % CI 2.0–10.9) in the control group. But there were no significant differences in every stage of AKI. Contradictorily, the incidence of RRT was slightly higher in the RIPC group than in the control group (4.6 % [95 % CI 2.7–7.8] vs 3.2 % [95 % CI 1.6–6.4], RR 1.116 [95 % CI 0.524–2.377], P = 0.776). In addition, RIPC significantly reduced the incidence of AKI in the CI-AKI subgroup from 13.5 % to 6.5 % (RR 0.430, 95 % CI 0.286–0.648, P = 0.000), but not in the IR-AKI subgroup, in which it reduced the incidence from 29.5 % to 24.7 % (RR 0.905, 95 % CI 0.783–1.045, P = 0.173). There was a significant difference between these two subgroups (P = 0.001) (Figs. 2 and 3).Fig. 2


Protection of remote ischemic preconditioning against acute kidney injury: a systematic review and meta-analysis.

Hu J, Liu S, Jia P, Xu X, Song N, Zhang T, Chen R, Ding X - Crit Care (2016)

Effects of remote ischemic preconditioning (RIPC) on the incidence of acute kidney injury (AKI). (a) Effects of RIPC on total AKI, ischemia/reperfusion-induced AKI (IR-AKI) and contrast-induced AKI (CI-AKI). (b) Effects of RIPC on every stage of AKI. **P < 0.01
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837562&req=5

Fig2: Effects of remote ischemic preconditioning (RIPC) on the incidence of acute kidney injury (AKI). (a) Effects of RIPC on total AKI, ischemia/reperfusion-induced AKI (IR-AKI) and contrast-induced AKI (CI-AKI). (b) Effects of RIPC on every stage of AKI. **P < 0.01
Mentions: Data regarding the incidence of AKI were available in 26 trials with an aggregated 7009 patients. The total pooled incidence of AKI in the RIPC group was 11.5 % (95 % CI 8.5–15.3), which was significantly lower than the 23.3 % (95 % CI 16.6–31.8) in the control group (RR 0.834, 95 % CI 0.728–0.955, P = 0.009). Nine studies with an aggregated 2504 patients after cardiac surgery provided the incidence in every stage of AKI. The pooled incidence rates were 17.5 % (95 % CI 11.6–25.5), 7.9 % (95 % CI 4.1–14.7), and 4.2 % (95 % CI 2.3–7.2) for stage 1, stage 2, and stage 3 AKI, respectively, in the RIPC group. The corresponding rates were 26.8 % (95 % CI 21.7–32.4), 9.4 % (95 % CI 5.7–15.3), and 4.8 % (95 % CI 2.0–10.9) in the control group. But there were no significant differences in every stage of AKI. Contradictorily, the incidence of RRT was slightly higher in the RIPC group than in the control group (4.6 % [95 % CI 2.7–7.8] vs 3.2 % [95 % CI 1.6–6.4], RR 1.116 [95 % CI 0.524–2.377], P = 0.776). In addition, RIPC significantly reduced the incidence of AKI in the CI-AKI subgroup from 13.5 % to 6.5 % (RR 0.430, 95 % CI 0.286–0.648, P = 0.000), but not in the IR-AKI subgroup, in which it reduced the incidence from 29.5 % to 24.7 % (RR 0.905, 95 % CI 0.783–1.045, P = 0.173). There was a significant difference between these two subgroups (P = 0.001) (Figs. 2 and 3).Fig. 2

Bottom Line: Subgroup analyses indicated that RIPC significantly reduced the incidence of AKI in the contrast-induced AKI (CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %, P = 0.173).In addition, the length of ICU stay in the RIPC group was significantly shorter than in the control group (2.6 vs 2.0 days, P = 0.003).We found strong evidence to support the application of RIPC to prevent CI-AKI, but not IR-AKI.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.

ABSTRACT

Background: Remote ischemic preconditioning (RIPC) is a promising approach to preventing acute kidney injury (AKI), but its efficacy is controversial.

Methods: A systematic review of 30 randomized controlled trials was conducted to investigate the effects of RIPC on the incidence and outcomes of AKI. Random effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity. The primary outcome was incidence of AKI and hospital mortality.

Results: The total pooled incidence of AKI in the RIPC group was 11.5 %, significantly less than the 23.3 % incidence in the control group (P = 0.009). Subgroup analyses indicated that RIPC significantly reduced the incidence of AKI in the contrast-induced AKI (CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %, P = 0.173). Random effects meta-regression indicated that RIPC tended to strengthen its renoprotective effect (q = 3.95, df = 1, P = 0.047) in these trials with a higher percentage of diabetes mellitus. RIPC had no significant effect on the incidence of stages 1-3 AKI or renal replacement therapy, change in serum creatinine and estimated glomerular filtration rate (eGFR), hospital or 30-day mortality, or length of hospital stay. But RIPC significantly increased the minimum eGFR in the IR-AKI subgroup (P = 0.006) compared with the control group. In addition, the length of ICU stay in the RIPC group was significantly shorter than in the control group (2.6 vs 2.0 days, P = 0.003).

Conclusions: We found strong evidence to support the application of RIPC to prevent CI-AKI, but not IR-AKI.

No MeSH data available.


Related in: MedlinePlus