The Effect of Remote Ischemic Preconditioning on Elective Percutaneous Coronary Intervention in Diabetic Nephropathy
Condition: Contrast Induced Acute Kidney Injury
MeSH terms: Acute Kidney Injury
Study type: Interventional

Summary: 
      Contrast-induced acute kidney injury (CI-AKI) is a significant iatrogenic complication of
      contrast media use associated with prolonged hospitalization, cardiovascular events,
      persistent kidney damage and increased risk of all-cause mortality. When remote ischemic
      preconditioning is applied before percutaneous coronary intervention (PCI), the kidneys can
      be protected against ischemia-reperfusion injury and subsequently CI-AKI. In this randomised
      controlled trial, diabetic nephropathy patients undergoing PCI as part of their assessment
      and treatment of cardiovascular disease are randomized to receive RIPC or control sham
      preconditioning.
    

Detailed description: 
      Contrast-induced acute kidney injury (CI-AKI) is a significant iatrogenic complication of
      contrast media use associated with prolonged hospitalization, cardiovascular events,
      persistent kidney damage and increased risk of all-cause mortality. Diabetes with
      pre-existing renal disease can increase the risk of CI-AKI. Remote ischemic preconditioning
      (RIPC) is a non-pharmacological strategy inducing transient episodes of ischemia by the
      occlusion of blood flow in non-target tissue such as a limb, before a subsequent prolonged
      ischemia-reperfusion injury occurs in a more distant organ. These brief, repeated ischemic
      episodes in the limb can confer a protection at more remote sites such as the heart, brain,
      lung, kidney, intestine or skeletal muscle. In a recent pilot study, using RIPC prior to
      coronary angiography in high risk patients with moderate chronic kidney disease, the authors
      found that RIPC significantly reduced the incidence of CI-AKI (Er et al Circulation.
      2012;126(3),296). We hypothesized that RIPC would be protective as an adjunctive therapy in
      reducing the incidence of CI-AKI in diabetics with pre-existing CKD. This prospective study
      was performed to evaluate the efficacy of RIPC for the prevention of CI-AKI among diabetic
      nephropathy patients undergoing percutaneous coronary intervention.
    

Intervention name(s): Remote ischemic preconditioning; Sham ischemic preconditioning
Intervention type(s): Procedure; Procedure
Intervention description(s): Appropriately sized sphygmomanometer cuff placed around right upper arm; where contraindicated, left arm, with inflation of the cuff up to 200mmHg for 5 minutes, followed by deflation of 5 minutes to allow reperfusion with cycle repeated 3 times.; Appropriately sized sphygmomanometer cuff placed around right upper arm; where contraindicated, left arm, with inflation of the cuff up to 50mmHg for 5 minutes, followed by deflation of 5 minutes to allow reperfusion with cycle repeated 3 times.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment