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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

Forest plot showing effects of remote ischemic preconditioning on the change of serum creatinine within 72 h after procedures. IR-AKI ischemia/reperfusion-induced acute kidney injury, CI-AKI contrast-induced acute kidney injury, RIPC remote ischemic preconditioning, SD standard deviation, Std Diff standard difference
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Fig6: Forest plot showing effects of remote ischemic preconditioning on the change of serum creatinine within 72 h after procedures. IR-AKI ischemia/reperfusion-induced acute kidney injury, CI-AKI contrast-induced acute kidney injury, RIPC remote ischemic preconditioning, SD standard deviation, Std Diff standard difference

Mentions: Data about maximum SCr values within 72 h after procedures were available in 13 trials; maximum increase of SCr was available in 6 trials; and minimum eGFR values were available in 7 trials. There were no significant differences in these indexes for total AKI and subgroups between the control and RIPC groups, except that RIPC increased the minimum eGFR in the IR-AKI subgroup (P = 0.006) compared with the control group (Figs. 5, 6 and 7).Fig. 5


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)

Forest plot showing effects of remote ischemic preconditioning on the change of serum creatinine within 72 h after procedures. IR-AKI ischemia/reperfusion-induced acute kidney injury, CI-AKI contrast-induced acute kidney injury, RIPC remote ischemic preconditioning, SD standard deviation, Std Diff standard difference
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Forest plot showing effects of remote ischemic preconditioning on the change of serum creatinine within 72 h after procedures. IR-AKI ischemia/reperfusion-induced acute kidney injury, CI-AKI contrast-induced acute kidney injury, RIPC remote ischemic preconditioning, SD standard deviation, Std Diff standard difference
Mentions: Data about maximum SCr values within 72 h after procedures were available in 13 trials; maximum increase of SCr was available in 6 trials; and minimum eGFR values were available in 7 trials. There were no significant differences in these indexes for total AKI and subgroups between the control and RIPC groups, except that RIPC increased the minimum eGFR in the IR-AKI subgroup (P = 0.006) compared with the control group (Figs. 5, 6 and 7).Fig. 5

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