Remote ischaemic conditioning for prevention of acute kidney injury after valvular heart surgery: a randomised controlled trial

J. W. Song, W. K. Lee, S. Lee, J. K. Shim, H. J. Kim, Y. L. Kwak

Research output: Contribution to journalArticle

Abstract

Background: Repeated remote ischaemic conditioning (RIC) during weaning from cardiopulmonary bypass and in the early postoperative period may confer protection against acute kidney injury (AKI). We evaluated the effect of repeated RIC on the incidence of AKI in patients undergoing valvular heart surgery. Methods: Patients were randomised into either the RIC (n=120) or control (n=124) group. A pneumatic tourniquet was placed on each patient's thigh. Upon removal of the aortic cross-clamp, three cycles of inflation for 5 min at 250 mm Hg (with 5 min intervals) were applied in the RIC group. Additionally, three cycles of RIC were repeated at postoperative 12 and 24 h. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes guideline. The incidences of renal replacement therapy, permanent stroke, sternal wound infection, newly developed atrial fibrillation, mechanical ventilation >24 h, and reoperation for bleeding during hospitalisation were recorded. Results: The incidences of AKI were not significantly different between the control (19.4%) and RIC (15.8%) groups (a difference of 3.5 percentage points; 95% confidence interval: –6.8%–13.9%; P=0.470). Perioperative serum creatinine concentrations were similar in the control and RIC groups (P=0.494). Fluid balance, urine output, blood loss, transfusion, and vasopressor/inotropic requirements were not significantly different between the groups (all P>0.05). The occurrences of a composite of morbidity and mortality endpoints were not significantly different between the control (46.0%) and RIC (39.2%) groups (a difference of 6.8 percentage points; 95% confidence interval: –6.4%–20.0%; P=0.283). Conclusions: The results of our study do not support repeated RIC to decrease the incidence of AKI after valvular heart surgery. Clinical trial registration: NCT02720549.

Original languageEnglish
Pages (from-to)1034-1040
Number of pages7
JournalBritish Journal of Anaesthesia
Volume121
Issue number5
DOIs
Publication statusPublished - 2018 Nov

Fingerprint

Acute Kidney Injury
Thoracic Surgery
Randomized Controlled Trials
Incidence
Confidence Intervals
Tourniquets
Water-Electrolyte Balance
Renal Replacement Therapy
Economic Inflation
Kidney Diseases
Wound Infection
Thigh
Cardiopulmonary Bypass
Reoperation
Artificial Respiration
Postoperative Period
Blood Transfusion
Atrial Fibrillation
Creatinine
Hospitalization

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

@article{c934651f49a54fc390302e995b6c0c06,
title = "Remote ischaemic conditioning for prevention of acute kidney injury after valvular heart surgery: a randomised controlled trial",
abstract = "Background: Repeated remote ischaemic conditioning (RIC) during weaning from cardiopulmonary bypass and in the early postoperative period may confer protection against acute kidney injury (AKI). We evaluated the effect of repeated RIC on the incidence of AKI in patients undergoing valvular heart surgery. Methods: Patients were randomised into either the RIC (n=120) or control (n=124) group. A pneumatic tourniquet was placed on each patient's thigh. Upon removal of the aortic cross-clamp, three cycles of inflation for 5 min at 250 mm Hg (with 5 min intervals) were applied in the RIC group. Additionally, three cycles of RIC were repeated at postoperative 12 and 24 h. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes guideline. The incidences of renal replacement therapy, permanent stroke, sternal wound infection, newly developed atrial fibrillation, mechanical ventilation >24 h, and reoperation for bleeding during hospitalisation were recorded. Results: The incidences of AKI were not significantly different between the control (19.4{\%}) and RIC (15.8{\%}) groups (a difference of 3.5 percentage points; 95{\%} confidence interval: –6.8{\%}–13.9{\%}; P=0.470). Perioperative serum creatinine concentrations were similar in the control and RIC groups (P=0.494). Fluid balance, urine output, blood loss, transfusion, and vasopressor/inotropic requirements were not significantly different between the groups (all P>0.05). The occurrences of a composite of morbidity and mortality endpoints were not significantly different between the control (46.0{\%}) and RIC (39.2{\%}) groups (a difference of 6.8 percentage points; 95{\%} confidence interval: –6.4{\%}–20.0{\%}; P=0.283). Conclusions: The results of our study do not support repeated RIC to decrease the incidence of AKI after valvular heart surgery. Clinical trial registration: NCT02720549.",
author = "Song, {J. W.} and Lee, {W. K.} and S. Lee and Shim, {J. K.} and Kim, {H. J.} and Kwak, {Y. L.}",
year = "2018",
month = "11",
doi = "10.1016/j.bja.2018.07.035",
language = "English",
volume = "121",
pages = "1034--1040",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "5",

}

Remote ischaemic conditioning for prevention of acute kidney injury after valvular heart surgery : a randomised controlled trial. / Song, J. W.; Lee, W. K.; Lee, S.; Shim, J. K.; Kim, H. J.; Kwak, Y. L.

In: British Journal of Anaesthesia, Vol. 121, No. 5, 11.2018, p. 1034-1040.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Remote ischaemic conditioning for prevention of acute kidney injury after valvular heart surgery

T2 - a randomised controlled trial

AU - Song, J. W.

AU - Lee, W. K.

AU - Lee, S.

AU - Shim, J. K.

AU - Kim, H. J.

AU - Kwak, Y. L.

PY - 2018/11

Y1 - 2018/11

N2 - Background: Repeated remote ischaemic conditioning (RIC) during weaning from cardiopulmonary bypass and in the early postoperative period may confer protection against acute kidney injury (AKI). We evaluated the effect of repeated RIC on the incidence of AKI in patients undergoing valvular heart surgery. Methods: Patients were randomised into either the RIC (n=120) or control (n=124) group. A pneumatic tourniquet was placed on each patient's thigh. Upon removal of the aortic cross-clamp, three cycles of inflation for 5 min at 250 mm Hg (with 5 min intervals) were applied in the RIC group. Additionally, three cycles of RIC were repeated at postoperative 12 and 24 h. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes guideline. The incidences of renal replacement therapy, permanent stroke, sternal wound infection, newly developed atrial fibrillation, mechanical ventilation >24 h, and reoperation for bleeding during hospitalisation were recorded. Results: The incidences of AKI were not significantly different between the control (19.4%) and RIC (15.8%) groups (a difference of 3.5 percentage points; 95% confidence interval: –6.8%–13.9%; P=0.470). Perioperative serum creatinine concentrations were similar in the control and RIC groups (P=0.494). Fluid balance, urine output, blood loss, transfusion, and vasopressor/inotropic requirements were not significantly different between the groups (all P>0.05). The occurrences of a composite of morbidity and mortality endpoints were not significantly different between the control (46.0%) and RIC (39.2%) groups (a difference of 6.8 percentage points; 95% confidence interval: –6.4%–20.0%; P=0.283). Conclusions: The results of our study do not support repeated RIC to decrease the incidence of AKI after valvular heart surgery. Clinical trial registration: NCT02720549.

AB - Background: Repeated remote ischaemic conditioning (RIC) during weaning from cardiopulmonary bypass and in the early postoperative period may confer protection against acute kidney injury (AKI). We evaluated the effect of repeated RIC on the incidence of AKI in patients undergoing valvular heart surgery. Methods: Patients were randomised into either the RIC (n=120) or control (n=124) group. A pneumatic tourniquet was placed on each patient's thigh. Upon removal of the aortic cross-clamp, three cycles of inflation for 5 min at 250 mm Hg (with 5 min intervals) were applied in the RIC group. Additionally, three cycles of RIC were repeated at postoperative 12 and 24 h. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes guideline. The incidences of renal replacement therapy, permanent stroke, sternal wound infection, newly developed atrial fibrillation, mechanical ventilation >24 h, and reoperation for bleeding during hospitalisation were recorded. Results: The incidences of AKI were not significantly different between the control (19.4%) and RIC (15.8%) groups (a difference of 3.5 percentage points; 95% confidence interval: –6.8%–13.9%; P=0.470). Perioperative serum creatinine concentrations were similar in the control and RIC groups (P=0.494). Fluid balance, urine output, blood loss, transfusion, and vasopressor/inotropic requirements were not significantly different between the groups (all P>0.05). The occurrences of a composite of morbidity and mortality endpoints were not significantly different between the control (46.0%) and RIC (39.2%) groups (a difference of 6.8 percentage points; 95% confidence interval: –6.4%–20.0%; P=0.283). Conclusions: The results of our study do not support repeated RIC to decrease the incidence of AKI after valvular heart surgery. Clinical trial registration: NCT02720549.

UR - http://www.scopus.com/inward/record.url?scp=85053687718&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053687718&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2018.07.035

DO - 10.1016/j.bja.2018.07.035

M3 - Article

C2 - 30336847

AN - SCOPUS:85053687718

VL - 121

SP - 1034

EP - 1040

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 5

ER -