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

Title
 Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery: a randomized controlled trial. 
Authors
 Yong Seon Choi ; Jae Kwang Shim ; Young Lan Kwak ; Ki-Ryang Ahn ; Yong Han Seo ; Kyu-Sik Kang ; Jong Chan Kim 
Issue Date
2011
Journal Title
 Journal of Thoracic and Cardiovascular Surgery 
ISSN
 0022-5223 
Citation
 Journal of Thoracic and Cardiovascular Surgery, Vol.142(1) : 148~154, 2011 
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.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/93322
DOI
10.1016/j.jtcvs.2010.11.018
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Anesthesiology and Pain Medicine
Yonsei Authors
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Link
 http://www.sciencedirect.com/science/article/pii/S0022522310013334
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