Failure of remote ischemic preconditioning to reduce the risk of postoperative acute kidney injury in children undergoing operation for complex congenital heart disease: a randomized single-center study

J Thorac Cardiovasc Surg. 2012 Mar;143(3):576-83. doi: 10.1016/j.jtcvs.2011.08.044. Epub 2011 Sep 28.


Objective: The objective of this study was to evaluate whether remote ischemic preconditioning can protect kidney function in children undergoing operation for complex congenital heart disease.

Methods: Children (n = 113) aged 0 to 15 years admitted for complex congenital heart disease were randomly allocated according to age to remote ischemic preconditioning and control groups. After exclusion of 8 patients, we conducted the analysis on 105 patients (remote ischemic preconditioning group, n = 54; control group, n = 51). Before surgery, remote ischemic preconditioning was performed as 4 cycles of 5 minutes of ischemia by inflating a cuff around a leg to 40 mm Hg above the systolic pressure. End points were development of acute kidney injury, initiation of dialysis, plasma creatinine, estimated glomerular filtration rate, plasma cystatin C, plasma and urinary neutrophil gelatinase-associated lipocalin, and urinary output. Secondary end points included postoperative blood pressure, inotropic score, and mortality, as well as morbidity reflected by reoperation and stays in the intensive care unit and hospital.

Results: Overall, 57 of the children (54%) had acute kidney injury develop, with 27 (50%) in the remote ischemic preconditioning group and 30 (59%) in the control group (P > .2). Remote ischemic preconditioning was not associated with improvement in either any of the renal biomarkers or any of the secondary end points.

Conclusions: We found no evidence that remote ischemic preconditioning provided protection of kidney function in children undergoing operation for complex congenital heart disease.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / prevention & control*
  • Acute Kidney Injury / urine
  • Acute-Phase Proteins / urine
  • Adolescent
  • Biomarkers / blood
  • Biomarkers / urine
  • Cardiac Surgical Procedures / adverse effects*
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Creatinine / blood
  • Cystatin C / blood
  • Denmark
  • Female
  • Glomerular Filtration Rate
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Ischemic Preconditioning / methods*
  • Kidney / metabolism
  • Kidney / physiopathology
  • Likelihood Functions
  • Lipocalin-2
  • Lipocalins / urine
  • Lower Extremity / blood supply*
  • Male
  • Proto-Oncogene Proteins / urine
  • Renal Dialysis
  • Time Factors
  • Treatment Failure
  • Urination


  • Acute-Phase Proteins
  • Biomarkers
  • CST3 protein, human
  • Cystatin C
  • LCN2 protein, human
  • Lipocalin-2
  • Lipocalins
  • Proto-Oncogene Proteins
  • Creatinine