Ischemic preconditioning for prevention of contrast medium-induced nephropathy: randomized pilot RenPro Trial (Renal Protection Trial)

Circulation. 2012 Jul 17;126(3):296-303. doi: 10.1161/CIRCULATIONAHA.112.096370. Epub 2012 Jun 26.


Background: Contrast medium-induced acute kidney injury is associated with substantial morbidity and mortality. The underlying mechanism has been attributed in part to ischemic kidney injury. The aim of this randomized, double-blind, sham-controlled trial was to assess the impact of remote ischemic preconditioning on contrast medium-induced acute kidney injury.

Methods and results: Patients with impaired renal function (serum creatinine >1.4 mg/dL or estimated glomerular filtration rate <60 mL · min(-1) · 1.73 m(-2)) undergoing elective coronary angiography were randomized in a 1:1 ratio to standard care with (n=50) or without ischemic preconditioning (n=50; intermittent arm ischemia through 4 cycles of 5-minute inflation and 5-minute deflation of a blood pressure cuff). Overall, both study groups were at high risk of developing contrast medium-induced acute kidney injury according to the Mehran risk score. The primary end point was the incidence of contrast medium-induced kidney injury, defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dL above baseline at 48 hours after contrast medium exposure. Contrast medium-induced acute kidney injury occurred in 26 patients (26%), 20 (40%) in the control group and 6 (12%) in the remote ischemic preconditioning group (odds ratio, 0.21; 95% confidence interval, 0.07-0.57; P=0.002). No major adverse events were related to remote ischemic preconditioning.

Conclusions: Remote ischemic preconditioning before contrast medium use prevents contrast medium-induced acute kidney injury in high-risk patients. Our findings merit a larger trial to establish the effect of remote ischemic preconditioning on clinical outcomes.

Clinical trial registration: URL: Unique identifier: U1111-1118-8098.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / prevention & control*
  • Aged
  • Aged, 80 and over
  • Arm / blood supply
  • Blood Pressure Monitors
  • Contrast Media / adverse effects*
  • Coronary Angiography / adverse effects
  • Coronary Angiography / methods
  • Coronary Artery Bypass
  • Creatinine / blood
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology
  • Heart Diseases / diagnostic imaging*
  • Heart Diseases / mortality
  • Heart Diseases / surgery
  • Heart Valve Prosthesis Implantation
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Ischemic Preconditioning / methods*
  • Male
  • Middle Aged
  • Morbidity
  • Pilot Projects
  • Risk Factors


  • Contrast Media
  • Creatinine