Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery: A randomized controlled trial

Yong Seon Choi, Jae Kwang Shim, Jong Chan Kim, Kyu Sik Kang, Yong Han Seo, Ki Ryang Ahn, Younglan Kwak

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Objective: Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery. Methods: Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters. Results: There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group. Conclusions: In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay.

Original languageEnglish
Pages (from-to)148-154
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume142
Issue number1
DOIs
Publication statusPublished - 2011 Jul 1

Fingerprint

Ischemic Preconditioning
Thoracic Surgery
Randomized Controlled Trials
Kidney
Acute Kidney Injury
Ischemia
Wounds and Injuries
Intensive Care Units
Incidence
Biomarkers
Cystatin C
MB Form Creatine Kinase
Control Groups
Reperfusion Injury
Serum
Cardiopulmonary Bypass
Isoenzymes
Reperfusion
Lower Extremity
Creatinine

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Choi, Yong Seon ; Shim, Jae Kwang ; Kim, Jong Chan ; Kang, Kyu Sik ; Seo, Yong Han ; Ahn, Ki Ryang ; Kwak, Younglan. / Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery : A randomized controlled trial. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 142, No. 1. pp. 148-154.
@article{3bb5aad5a7af49f29bc90ed8ed13ce3a,
title = "Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery: A randomized controlled trial",
abstract = "Objective: Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery. Methods: Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters. Results: There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group. Conclusions: In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay.",
author = "Choi, {Yong Seon} and Shim, {Jae Kwang} and Kim, {Jong Chan} and Kang, {Kyu Sik} and Seo, {Yong Han} and Ahn, {Ki Ryang} and Younglan Kwak",
year = "2011",
month = "7",
day = "1",
doi = "10.1016/j.jtcvs.2010.11.018",
language = "English",
volume = "142",
pages = "148--154",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "1",

}

Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery : A randomized controlled trial. / Choi, Yong Seon; Shim, Jae Kwang; Kim, Jong Chan; Kang, Kyu Sik; Seo, Yong Han; Ahn, Ki Ryang; Kwak, Younglan.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 142, No. 1, 01.07.2011, p. 148-154.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery

T2 - A randomized controlled trial

AU - Choi, Yong Seon

AU - Shim, Jae Kwang

AU - Kim, Jong Chan

AU - Kang, Kyu Sik

AU - Seo, Yong Han

AU - Ahn, Ki Ryang

AU - Kwak, Younglan

PY - 2011/7/1

Y1 - 2011/7/1

N2 - Objective: Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery. Methods: Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters. Results: There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group. Conclusions: In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay.

AB - Objective: Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery. Methods: Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters. Results: There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group. Conclusions: In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay.

UR - http://www.scopus.com/inward/record.url?scp=79959354607&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959354607&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2010.11.018

DO - 10.1016/j.jtcvs.2010.11.018

M3 - Article

C2 - 21272897

AN - SCOPUS:79959354607

VL - 142

SP - 148

EP - 154

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 1

ER -