Remote ischemic preconditioning to reduce contrast-induced acute kidney injury in chronic kidney disease: a randomized controlled trial

BMC Nephrol. 2018 Dec 22;19(1):373. doi: 10.1186/s12882-018-1169-x.


Background: The impact of contrast-induced acute kidney injury (CI-AKI) on patients with chronic renal disease is well-known. Remote ischemic preconditioning (RIPC) is a non-invasive method that can reduce the risk of CI-AKI, but studies on RIPC have had different results. The aim of the present study was to assess the potential impact of RIPC on CI-AKI.

Methods: In a randomized, double blinded, controlled trial, 132 patients with chronic renal dysfunction (glomerular filtration rate < 60 mL/min/m2) who underwent coronary angiography or angioplasty received adequate hydration. RIPC was performed in 66 patients by applying an upper arm blood pressure cuff. The cuff was inflated four times for 5 min to 50 mmHg above the systolic blood pressure, followed by deflation for 5 min. In the control group, the blood pressure cuff was inflated only to 10 mmHg below the patient's diastolic blood pressure. The primary endpoint was an increase in serum cystatin C ≥ 10% from baseline to 48-72 h after exposure to the contrast.

Results: The primary endpoint was achieved in 48 (36.4%) patients (24 in each group). RIPC did not show any significant effect on the occurrence of the primary endpoint (P = 1). In addition, when the results were analyzed based on the Mehran risk score for subgroups of patients, RIPC did not reduce the occurrence of the primary endpoint (P = 0.97).

Conclusions: In patients at moderate-to-high risk of developing CI-AKI when an adequate hydration protocol is performed, RIPC does not have an additive effect to prevent the occurrence of CI-AKI.

Trial registration: The clinical trial was registered on (Identification number IRCT2016050222935N2 , on December 19, 2016 as a retrospective IRCT).

Keywords: Acute kidney injury; Contrast-induced nephropathy; Coronary angiography; Remote ischemic preconditioning.

Publication types

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

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / prevention & control*
  • Aged
  • Angioplasty
  • Contrast Media / adverse effects*
  • Coronary Angiography
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / therapy
  • Cystatin C / blood*
  • Double-Blind Method
  • Female
  • Fluid Therapy
  • Humans
  • Ischemic Preconditioning / methods*
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Insufficiency, Chronic / complications*


  • Contrast Media
  • Cystatin C

Associated data

  • IRCT/IRCT2016050222935N2