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Effect of Delayed Remote Ischemic Preconditioning on Acute Kidney Injury and Outcomes in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial.
Jia, Ping; Ji, Qiang; Zou, Zhouping; Zeng, Qi; Ren, Ting; Chen, Weize; Yan, Zhixin; Shen, Daoqi; Li, Yang; Peng, Fangyuan; Su, Ying; Xu, Jiarui; Shen, Bo; Luo, Zhe; Wang, Chunsheng; Ding, Xiaoqiang.
Afiliação
  • Jia P; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Ji Q; Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai. (Q.J., C.W.).
  • Zou Z; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Zeng Q; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Ren T; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Chen W; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Yan Z; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Shen D; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Li Y; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Peng F; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Su Y; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai. (Y.S., Z.L.).
  • Xu J; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Shen B; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
  • Luo Z; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai. (Y.S., Z.L.).
  • Wang C; Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai. (Q.J., C.W.).
  • Ding X; Department of Nephrology, Zhongshan Hospital, Fudan University, and Shanghai Medical Center of Kidney, and Shanghai Key Laboratory of Kidney and Blood Purification, China (P.J., Z.Z., Q.Z., T.R., W.C., Z.Y., D.S., Y.L., F.P., B.S., J.X., X.D.).
Circulation ; 2024 Sep 25.
Article em En | MEDLINE | ID: mdl-39319450
ABSTRACT

BACKGROUND:

Remote ischemic preconditioning (RIPC) has 2 time windows for organ protection acute and delayed. Previous studies have mainly focused on the organoprotective effects of acute RIPC. We aimed to determine whether delayed RIPC can reduce the occurrence of acute kidney injury (AKI) and postoperative complications in patients undergoing cardiac surgery.

METHODS:

This prospective, single-center, double-blind, randomized controlled trial involved 509 patients at high risk for AKI who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass. Patients were randomized to receive RIPC (4 cycles of 5-minute inflation and 5-minute deflation on 1 upper arm with a blood pressure cuff) 24 hours before surgery or a sham condition (control group) that was induced by 4 cycles of 5-minute inflation to a pressure of 20 mm Hg followed by 5-minute cuff deflation. The primary end point was the incidence of AKI within the prior 7 days after cardiac surgery. The secondary end points included renal replacement therapy during hospitalization, change in urinary biomarkers of AKI and markers of myocardial injury, duration of intensive care unit stay and mechanical ventilation, and occurrence of nonfatal myocardial infarction, stroke, and all-cause mortality by day 90.

RESULTS:

A total of 509 patients (mean age, 65.2±8.2 years; 348 men [68.4%]) were randomly assigned to the RIPC group (n=254) or control group (n=255). AKI was significantly reduced in the RIPC group compared with the control group (69/254 [27.2%] versus 90/255 [35.3%]; odds ratio, 0.68 [95% CI, 0.47-1.00]; P=0.048). There were no significant between-group differences in the secondary end points of perioperative myocardial injury (assessed by the concentrations of cardiac troponin T, creatine kinase myocardial isoenzyme, and NT-proBNP [N-terminal pro-brain natriuretic peptide]), duration of stay in the intensive care unit and hospital, and occurrence of nonfatal myocardial infarction, stroke, and all-cause mortality by day 90.

CONCLUSIONS:

Among high-risk patients undergoing cardiac surgery, delayed RIPC significantly reduced the occurrence of AKI. REGISTRATION URL https//www.chictr.org.cn; Unique identifier ChiCTR2000035568.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article
Texto completo
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XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article