Editorial Views  |   May 2017
The Devil Is in the Detail: Remote Ischemic Preconditioning for Perioperative Kidney Protection
Author Notes
  • From the Department of Anesthesiology, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany (F.K.); and Department of Anesthesiology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas (H.K.E.).
  • Accepted for publication January 25, 2017.
    Accepted for publication January 25, 2017.×
  • Corresponding article on page 787.
    Corresponding article on page 787.×
  • Address correspondence to Dr. Kork: fkork@ukaachen.de
Article Information
Editorial Views / Renal and Urinary Systems / Electrolyte Balance
Editorial Views   |   May 2017
The Devil Is in the Detail: Remote Ischemic Preconditioning for Perioperative Kidney Protection
Anesthesiology 5 2017, Vol.126, 763-765. doi:10.1097/ALN.0000000000001599
Anesthesiology 5 2017, Vol.126, 763-765. doi:10.1097/ALN.0000000000001599
ACUTE kidney injury (AKI) is a leading postoperative complication and is associated with higher mortality and higher morbidity.1  Even minor postoperative creatinine increases below AKI criteria are associated with adverse outcome in both noncardiac surgery2  and cardiac surgery patients.3  Hence, a method for the effective prevention of AKI is important and will eventually lead to the improvement of postoperative outcome. In the past, a variety of pharmacologic agents have been trialed for perioperative renoprotection (e.g., fenoldepam, statins, human atrial natriuretic peptide, and nesiritide) but without conclusive evidence supporting their use.1  In this issue of Anesthesiology, Zarbock et al.4  present data on the long-term renoprotective effect of remote ischemic preconditioning (RIPC). The authors show that RIPC significantly reduced major adverse kidney events at 90 days after cardiac surgery in patients at high risk for AKI. The results of this follow-up analysis of the effects of remote ischemic preconditioning on kidney injury in high-risk cardiac surgery patients (RenalRIP) trial deliver strong evidence that RIPC provides additional long-term kidney protection. In the primary analysis of their trial, Zarbock et al.5  had demonstrated RIPC to deliver short-term postoperative kidney protection: RIPC significantly reduced the rate of AKI and the use of renal replacement therapy compared to no ischemic preconditioning. RIPC could therefore be a promising method for protecting the kidney from ischemia-reperfusion injury.
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