Newly Published
Perioperative Medicine  |   March 2017
Long-term Effects of Remote Ischemic Preconditioning on Kidney Function in High-risk Cardiac Surgery Patients: Follow-up Results from the RenalRIP Trial
Author Notes
  • From the Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine (A.Z., H.V.A., C.S., M.K., M.M.) and Department of Cardiac Surgery (S.M.), University Hospital Münster, Münster, Germany; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (J.A.K.); Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany (P.R.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (D.G.).
  • Corresponding article on page XXX.
    Corresponding article on page XXX.×
  • Submitted for publication October 7, 2016. Accepted for publication January 27, 2017.
    Submitted for publication October 7, 2016. Accepted for publication January 27, 2017.×
  • Research Support: Supported by grant nos. ZA428/6-1 and ZA428/10-1 from the German Research Foundation (Bonn, Germany; to Dr. Zarbock) and by grant no. 2016_A97 from the Else Kröner Fresenius Stiftung (Bad Homburg, Germany).
    Research Support: Supported by grant nos. ZA428/6-1 and ZA428/10-1 from the German Research Foundation (Bonn, Germany; to Dr. Zarbock) and by grant no. 2016_A97 from the Else Kröner Fresenius Stiftung (Bad Homburg, Germany).×
  • Competing Interests: Dr. Zarbock and Dr. Kellum have received grant support and lecture fees from Astute Medical (San Diego, California), unrelated to the current study. Dr. Zarbock and Dr. Kellum have filed a patent application on the use of the biomarkers together with remote ischemic preconditioning. Dr. Meersch has received lecture fees from Astute Medical (San Diego, California), unrelated to the current study. The other authors declare no competing interests.
    Competing Interests: Dr. Zarbock and Dr. Kellum have received grant support and lecture fees from Astute Medical (San Diego, California), unrelated to the current study. Dr. Zarbock and Dr. Kellum have filed a patent application on the use of the biomarkers together with remote ischemic preconditioning. Dr. Meersch has received lecture fees from Astute Medical (San Diego, California), unrelated to the current study. The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Zarbock: Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany. zarbock@uni-muenster.de. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   March 2017
Long-term Effects of Remote Ischemic Preconditioning on Kidney Function in High-risk Cardiac Surgery Patients: Follow-up Results from the RenalRIP Trial
Anesthesiology Newly Published on March 16, 2017. doi:10.1097/ALN.0000000000001598
Anesthesiology Newly Published on March 16, 2017. doi:10.1097/ALN.0000000000001598
Abstract

Background: In a multicenter, randomized trial, the authors enrolled patients at high-risk for acute kidney injury as identified by a Cleveland Clinic Foundation score of 6 or more. The authors enrolled 240 patients at four hospitals and randomized them to remote ischemic preconditioning or control. The authors found that remote ischemic preconditioning reduced acute kidney injury in high-risk patients undergoing cardiac surgery. The authors now report on the effects of remote ischemic preconditioning on 90-day outcomes.

Methods: In this follow-up study of the RenalRIP trial, the authors examined the effect of remote ischemic preconditioning on the composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction at 90 days. Secondary outcomes were persistent renal dysfunction and dialysis dependence in patients with acute kidney injury.

Results: Remote ischemic preconditioning significantly reduced the occurrence of major adverse kidney events at 90 days (17 of 120 [14.2%]) versus control (30 of 120 [25.0%]; absolute risk reduction, 10.8%; 95% CI, 0.9 to 20.8%; P = 0.034). In those patients who developed acute kidney injury after cardiac surgery, 2 of 38 subjects in the remote ischemic preconditioning group (5.3%) and 13 of 56 subjects in the control group (23.2%) failed to recover renal function at 90 days (absolute risk reduction, 17.9%; 95% CI, 4.8 to 31.1%; P = 0.020). Acute kidney injury biomarkers were also increased in patients reaching the major adverse kidney event endpoint compared to patients who did not.

Conclusions: Remote ischemic preconditioning significantly reduced the 3-month incidence of a composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction in high-risk patients undergoing cardiac surgery. Furthermore, remote ischemic preconditioning enhanced renal recovery in patients with acute kidney injury.