Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography
Background: Patients undergoing invasive coronary angiography have an increased risk of acute kidney injury (AKI) for which there is no well-defined prophylactic therapy. Objectives: This study examined whether remote ischemic preconditioning (RIPC) reduces the rate of AKI in high-risk patients unde...
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Elsevier
2025-09-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25005174 |
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| author | Oladipupo Olafiranye, MD, MS Adam C. Straub, PhD Yingze Zhang, PhD Rahul Chaudhary, MD, MBA Megan P. Miller, BS Kathan Trivedi, MD Lawrence Hoang, MD Oussama Khalifa, MD Adetola Ladejobi, MD, MPH Floyd W. Thoma, BS Ning Feng, MD, PhD Aref Rahman, MD John A. Kellum, MD |
| author_facet | Oladipupo Olafiranye, MD, MS Adam C. Straub, PhD Yingze Zhang, PhD Rahul Chaudhary, MD, MBA Megan P. Miller, BS Kathan Trivedi, MD Lawrence Hoang, MD Oussama Khalifa, MD Adetola Ladejobi, MD, MPH Floyd W. Thoma, BS Ning Feng, MD, PhD Aref Rahman, MD John A. Kellum, MD |
| author_sort | Oladipupo Olafiranye, MD, MS |
| collection | DOAJ |
| description | Background: Patients undergoing invasive coronary angiography have an increased risk of acute kidney injury (AKI) for which there is no well-defined prophylactic therapy. Objectives: This study examined whether remote ischemic preconditioning (RIPC) reduces the rate of AKI in high-risk patients undergoing invasive coronary angiography. Methods: In this randomized sham-controlled trial, we enrolled high-risk patients undergoing coronary angiography between March 2018 and February 2023. Patients were randomly assigned 1:1 to RIPC or sham-RIPC. The primary outcome was the rate of AKI after coronary angiography. Secondary endpoints included changes in vascular and urinary biomarkers after RIPC, major adverse cardiovascular and cerebrovascular events (MACCE), and major adverse kidney events at 6-month follow-up. Results: A total of 109 patients (median age, 75 years) were randomized to RIPC (n = 54) and sham-RIPC (n = 55). The rate of AKI was lower in the RIPC compared to the sham-RIPC group (14.8% vs 29.1%; OR: 0.43; 95% CI: [0.17-0.94]; P = 0.030). The product of urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein-7, 2 markers of AKI, significantly increased at 48 hours post-angiography compared to pre-angiography level (0.51 vs 0.89; P = 0.004) in the sham-RIPC but not in the RIPC group (0.39 vs 0.68; P = 0.091). At 6-month follow-up, RIPC reduced the rate of MACCE (16.7% vs 36.4%; OR: 0.35; 95% CI: [0.14-0.87]; P = 0.029) but not major adverse kidney events (7.4% vs 10.4%; OR: 0.65; 95% CI: [0.17-2.46]; P = 0.740). Conclusions: In high-risk patients undergoing coronary angiography, RIPC reduced incidence of AKI and MACCE, and positively influenced biomarkers of kidney injury. (Biochemical Effects of Remote Ischemic Pre-Conditioning on Contrast-induced Acute Kidney Injury [BRICK]; NCT03236441) |
| format | Article |
| id | doaj-art-327a66fb078d493ca60fcd348fa6a8aa |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
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| series | JACC: Advances |
| spelling | doaj-art-327a66fb078d493ca60fcd348fa6a8aa2025-08-24T05:15:34ZengElsevierJACC: Advances2772-963X2025-09-014910209210.1016/j.jacadv.2025.102092Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary AngiographyOladipupo Olafiranye, MD, MS0Adam C. Straub, PhD1Yingze Zhang, PhD2Rahul Chaudhary, MD, MBA3Megan P. Miller, BS4Kathan Trivedi, MD5Lawrence Hoang, MD6Oussama Khalifa, MD7Adetola Ladejobi, MD, MPH8Floyd W. Thoma, BS9Ning Feng, MD, PhD10Aref Rahman, MD11John A. Kellum, MD12Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA; Division of Cardiology, Department of Medicine, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA; Address for correspondence: Dr Oladipupo Olafiranye, Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas 75231, Texas, USA.Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USAHeart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAHeart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Division of Cardiology, Department of Medicine, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USADepartment of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USADepartment of Medicine, Dallas Methodist Medical Center, Dallas, Texas, USADepartment of Medicine, Dallas Methodist Medical Center, Dallas, Texas, USAUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Division of Cardiology, Department of Medicine, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USADepartment of Cardiology, Memorial Healthcare System, Hollywood, Florida, USAUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAHeart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Division of Cardiology, Department of Medicine, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Division of Cardiology, Department of Medicine, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USACenter for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania, USABackground: Patients undergoing invasive coronary angiography have an increased risk of acute kidney injury (AKI) for which there is no well-defined prophylactic therapy. Objectives: This study examined whether remote ischemic preconditioning (RIPC) reduces the rate of AKI in high-risk patients undergoing invasive coronary angiography. Methods: In this randomized sham-controlled trial, we enrolled high-risk patients undergoing coronary angiography between March 2018 and February 2023. Patients were randomly assigned 1:1 to RIPC or sham-RIPC. The primary outcome was the rate of AKI after coronary angiography. Secondary endpoints included changes in vascular and urinary biomarkers after RIPC, major adverse cardiovascular and cerebrovascular events (MACCE), and major adverse kidney events at 6-month follow-up. Results: A total of 109 patients (median age, 75 years) were randomized to RIPC (n = 54) and sham-RIPC (n = 55). The rate of AKI was lower in the RIPC compared to the sham-RIPC group (14.8% vs 29.1%; OR: 0.43; 95% CI: [0.17-0.94]; P = 0.030). The product of urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein-7, 2 markers of AKI, significantly increased at 48 hours post-angiography compared to pre-angiography level (0.51 vs 0.89; P = 0.004) in the sham-RIPC but not in the RIPC group (0.39 vs 0.68; P = 0.091). At 6-month follow-up, RIPC reduced the rate of MACCE (16.7% vs 36.4%; OR: 0.35; 95% CI: [0.14-0.87]; P = 0.029) but not major adverse kidney events (7.4% vs 10.4%; OR: 0.65; 95% CI: [0.17-2.46]; P = 0.740). Conclusions: In high-risk patients undergoing coronary angiography, RIPC reduced incidence of AKI and MACCE, and positively influenced biomarkers of kidney injury. (Biochemical Effects of Remote Ischemic Pre-Conditioning on Contrast-induced Acute Kidney Injury [BRICK]; NCT03236441)http://www.sciencedirect.com/science/article/pii/S2772963X25005174cardiac catheterizationcontrast-induced nephropathyischemic conditioning |
| spellingShingle | Oladipupo Olafiranye, MD, MS Adam C. Straub, PhD Yingze Zhang, PhD Rahul Chaudhary, MD, MBA Megan P. Miller, BS Kathan Trivedi, MD Lawrence Hoang, MD Oussama Khalifa, MD Adetola Ladejobi, MD, MPH Floyd W. Thoma, BS Ning Feng, MD, PhD Aref Rahman, MD John A. Kellum, MD Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography JACC: Advances cardiac catheterization contrast-induced nephropathy ischemic conditioning |
| title | Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography |
| title_full | Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography |
| title_fullStr | Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography |
| title_full_unstemmed | Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography |
| title_short | Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography |
| title_sort | remote ischemic preconditioning prevents acute kidney injury following coronary angiography |
| topic | cardiac catheterization contrast-induced nephropathy ischemic conditioning |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25005174 |
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