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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

Meta-regression results of reduction of acute kidney injury (AKI) by remote ischemic preconditioning (RIPC). Meta-regression of age (a), percentage of male (b), percentage of hypertension (c), percentage of diabetes mellitus (DM) (d), percentage of dyslipidemia (e), baseline estimated glomerular filtration (eGFR) (f), cardiopulmonary bypass (CPB) time (g), cross-clamp time (h) and dose of contrast medium (i) on log risk ratios
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Fig4: Meta-regression results of reduction of acute kidney injury (AKI) by remote ischemic preconditioning (RIPC). Meta-regression of age (a), percentage of male (b), percentage of hypertension (c), percentage of diabetes mellitus (DM) (d), percentage of dyslipidemia (e), baseline estimated glomerular filtration (eGFR) (f), cardiopulmonary bypass (CPB) time (g), cross-clamp time (h) and dose of contrast medium (i) on log risk ratios

Mentions: Random effects meta-regression showed that RIPC tended to strengthen its renoprotection with a significant difference (q = 3.95, df = 1, P = 0.047) along with a higher percentage of DM. We did not find any other significant correlation between the incidence of AKI and probable confounding factors such as age, percentage of male patients, other comorbidities, baseline eGFR, CPB and cross-clamp time, and dose of contrast medium (Fig. 4).Fig. 4


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)

Meta-regression results of reduction of acute kidney injury (AKI) by remote ischemic preconditioning (RIPC). Meta-regression of age (a), percentage of male (b), percentage of hypertension (c), percentage of diabetes mellitus (DM) (d), percentage of dyslipidemia (e), baseline estimated glomerular filtration (eGFR) (f), cardiopulmonary bypass (CPB) time (g), cross-clamp time (h) and dose of contrast medium (i) on log risk ratios
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Meta-regression results of reduction of acute kidney injury (AKI) by remote ischemic preconditioning (RIPC). Meta-regression of age (a), percentage of male (b), percentage of hypertension (c), percentage of diabetes mellitus (DM) (d), percentage of dyslipidemia (e), baseline estimated glomerular filtration (eGFR) (f), cardiopulmonary bypass (CPB) time (g), cross-clamp time (h) and dose of contrast medium (i) on log risk ratios
Mentions: Random effects meta-regression showed that RIPC tended to strengthen its renoprotection with a significant difference (q = 3.95, df = 1, P = 0.047) along with a higher percentage of DM. We did not find any other significant correlation between the incidence of AKI and probable confounding factors such as age, percentage of male patients, other comorbidities, baseline eGFR, CPB and cross-clamp time, and dose of contrast medium (Fig. 4).Fig. 4

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