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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 hospital or 30-day mortality due to acute kidney injury. IR-AKI ischemia/reperfusion-induced acute kidney injury, CI-AKI contrast-induced acute kidney injury, RIPC remote ischemic preconditioning, RR risk ratio
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Fig8: Forest plot showing effects of remote ischemic preconditioning on hospital or 30-day mortality due to acute kidney injury. IR-AKI ischemia/reperfusion-induced acute kidney injury, CI-AKI contrast-induced acute kidney injury, RIPC remote ischemic preconditioning, RR risk ratio

Mentions: Hospital or 30-day mortality rates were reported in 12 trials with an aggregated 5098 patients, but no significant differences were observed between the RIPC and control groups in total AKI (3.1 % vs 3.6 %, RR, 1.179, 95 % CI, 0.896–1.552, P = 0.240) and subgroup analyses (Figs. 5 and 8). In 10 trials with an aggregated 3874 patients, researchers reported the length of ICU stay, and in 15 trials with an aggregated 4231 patients investigators reported the length of hospital stay. RIPC reduced the length of ICU stay from 2.6 days (95 % CI 2.1–3.1) to 2.0 days (95 % CI 1.5–2.5) (standard difference in means −0.271, 95 % CI −0.447 to −0.095, P = 0.003), but it did not reduce the length of hospital stay (standard difference in means −0.022, 95 % CI −0.083 to 0.038, P = 0.469) (Figs. 5 and 9).Fig. 8


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 hospital or 30-day mortality due to acute kidney injury. IR-AKI ischemia/reperfusion-induced acute kidney injury, CI-AKI contrast-induced acute kidney injury, RIPC remote ischemic preconditioning, RR risk ratio
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig8: Forest plot showing effects of remote ischemic preconditioning on hospital or 30-day mortality due to acute kidney injury. IR-AKI ischemia/reperfusion-induced acute kidney injury, CI-AKI contrast-induced acute kidney injury, RIPC remote ischemic preconditioning, RR risk ratio
Mentions: Hospital or 30-day mortality rates were reported in 12 trials with an aggregated 5098 patients, but no significant differences were observed between the RIPC and control groups in total AKI (3.1 % vs 3.6 %, RR, 1.179, 95 % CI, 0.896–1.552, P = 0.240) and subgroup analyses (Figs. 5 and 8). In 10 trials with an aggregated 3874 patients, researchers reported the length of ICU stay, and in 15 trials with an aggregated 4231 patients investigators reported the length of hospital stay. RIPC reduced the length of ICU stay from 2.6 days (95 % CI 2.1–3.1) to 2.0 days (95 % CI 1.5–2.5) (standard difference in means −0.271, 95 % CI −0.447 to −0.095, P = 0.003), but it did not reduce the length of hospital stay (standard difference in means −0.022, 95 % CI −0.083 to 0.038, P = 0.469) (Figs. 5 and 9).Fig. 8

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