Title : Remote ischaemic preconditioning attenuates kidney injury in patients undergoing surgical lower limb revascularisation
Abstract:
Introduction: Perioperative acute kidney injury has been found to occur in 12% of patients undergoing lower limb revascularisation. Remote ischaemic preconditioning (RIPC) of short cycles of distant tissue ischaemia followed by reperfusion is a promising technique to reduce tissue damage from ischaemia-reperfusion injury. In a recent meta-analysis, RIPC was shown to reduce kidney injury in patients undergoing cardiac surgery. It has also been found to reduce serum creatinine postoperatively in patients undergoing abdominal aortic aneurysm repair. However, there are many uncertainties regarding clinical benefits from RIPC during vascular surgery. The aim of the current double-blinded, randomised and sham-controlled pilot study was to determine the effect of RIPC in perioperative renal damage in vascular surgery. Methods: The current study is a part of larger trial assessed the effect of RIPC in vascular surgery. Patients undergoing elective lower limb revascularisation surgery between January 2016 and February 2018, who gave full informed consent, were recruited. Stratified randomisation with a block design was used. Patient, patient’s physician and surgical team were blinded to study intervention. Four episodes of 5 minutes of upper limb ischaemia were performed preoperatively. In the sham group, pressure equal to venous pressure was applied instead of ischaemia. Between all episodes, there was a 5-minute period of reperfusion. Blood samples were collected preoperatively and 20?28 hours after surgery for assessment of biomarkers of acute kidney injury. Data were compared by means of t-tests, Wilcoxon’s tests or Chi-squared test. The study was approved by the Research Ethics Committee of the University of Tartu and registered in the ClinicalTrials. gov database (NCT02689414). Results: Twenty-eight patients were enrolled both in the sham and in the RIPC group. The baseline characteristics did not differ between the groups except for gender. The surgery resulted in statistically significant increase of creatinine and trends toward increases in urea, cystatin C and beta-2-microglobulin in the sham group. In the RIPC group, in contrast, significant decline in creatinine and cystatin C together with trends towards to reduction in urea and B2M was noted. Changes in creatinine, urea, cystatin C and B2M between the groups were statistically significant. Conclusion: This pilot study demonstrates that RIPC reduces the levels of biomarkers of acute kidney injury in patients undergoing surgical lower limb revascularisation. This phenomenon may offer renoprotection during vascular surgery. Audience Take Away: This pilot study demonstrates that simple non-invasive manipulation - remote ischaemic preconditioning - may offer renoprotection during vascular surgery
