Preventive Effects Of Remote Ischemic Preconditioning On Contrast Induced Nephropathy

BackgroundIn recent years,with the development of clinical diagnosis and interventional therapy,the use of contrast media is increasing day by day,Contrast-induced nephropathy(CIN)has become a common complication of cardiovascular interventional therapy.At present,in addition to hydration there is still no effective prophylactic regimen available to prevent occurrence of CIN,Therefore,it is urgent to explore a new method to reduce the incidence of CIN.Accumulated evidence indicates that renal ischemia and reperfusion injury is the main mechanism of CIN.Thus,the strategies for protecting against hypoxic injury may also be effective for prevention and treatment of CIN.Remote ischemic preconditioning(RIPC)is an effective endogenous protective mechanism against ischemia / reperfusion injury.It not only protects the heart,but also protects the other organs.The reports showed that RIPC can reduce myocardial ischemia reperfusion injury,but the prevention of CIN research at home and abroad is still in the initial stage,In this paper,we evaluated whether RIPC could reduce the incidence of CIN,to provide new measure for the prevention of CIN.ObjectiveTo observe the effects of RIPC applied before CAG or PCI on acute coronary syndrome(ACS)in patients with renal dysfunction,to provide theoretical guidance for the prevention of CIN in clinical application.MethodsFrom October 2015 to November 2016,a total of 107 patients with ACS complicated with renal insufficiency who were treated with CAG or PCI in the Department of Cardiology of Tai’an Central Hospital were selected in the study.All patients were randomized divided into two groups,RIPC group(n=50)and control group(n=57).The patients of RIPC group were received RIPC with blood pressure cuff to 200 mmHg around the upper arm at 2h before CAG by three 5-minute inflations and 5-minute reperfusion.Control group did not receive RIPC.The level of Scr,CysC,NGAL,eGFR were measured in all patients at 6 am befor the day of CAG,and 4hNGAL、24hCysC、72hScr and eGFR after CAG.The incidence of major adverse events in the kidney(the need for dialysis or renal replacement therapy after using contrast agent)and the composite endpoint of cardiovascular events were recorded at 1 month after CAG.Results1.The RIPC group and the control group compared to the baseline clinical characteristics of patients in the two groups,there were no significant differences in age,sex,medical history,medication,the dose of contrast medium,number of stent(P>0.05).2.Comparison intra-group: The Scr,CysC and blood NGAL in the two groups were higher than those before the operation,the difference was statistically significant(P<0.05),the level of eGFR was lower than that before operation,the difference was statistically significant(P<0.05).3.Comparison among groups: The preoperative Scr,CysC,blood NGAL,eGFR levels of the differences between the two groups were not statistically significant(P>0.05).RIPC group compared with the control group,can reduce the level of CysC、Scr、blood NGAL after operation,and reduce the incidence of postoperative CIN,the differences were statistically significant(P<0.05),while the two group differences in the levels of eGFR reduction was not statistically significant(P>0.05).4.All patients were followed up for 1 month,the rate of readmission,mortality,renal dialysis and replacement therapy is of no statistically significant difference between patients in the two groups(P>0.05).5.The patients accepted the upper limps ischemic preconditioning for 5min ischemia(pressure 200mmHg)/5min reperfusion,we never observe any obvious adverse reactions untile 1 month after CAG.Conclusions1.The use of contrast medium can increase the degree of renal damage in patients with ACS combined with renal insufficiency.2.RIPC can reduce the degree of renal function damage in patients with ACS complicated with renal insufficiency after CAG.3.RIPC can reduce the incidence of postoperative CIN in patients with ACS complicated with renal insufficiency after CAG.4.RIPC for ACS in patients with renal dysfunction showed no effect on decreasing major adverse renal and MACE during 1month after CAG.5.The RIPC of 5min ischemia(pressure remains 200mmHg)/5min reperfusion with blood pressure cuff around the upper arm was safe.