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

Authors
 Yong Seon Choi  ;  Jae Kwang Shim  ;  Jong Chan Kim  ;  Kyu-Sik Kang  ;  Yong Han Seo  ;  Ki-Ryang Ahn  ;  Young Lan Kwak 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.142(1) : 148-154, 2011 
Journal Title
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN
 0022-5223 
Issue Date
2011
MeSH
Acute Kidney Injury/blood ; Acute Kidney Injury/etiology ; Acute Kidney Injury/prevention & control* ; Aged ; Biomarkers/blood ; Cardiac Surgical Procedures/adverse effects* ; Chi-Square Distribution ; Female ; Heart Valve Diseases/surgery* ; Heart Valves/surgery* ; Humans ; Intensive Care Units ; Ischemic Preconditioning* ; Length of Stay ; Lower Extremity/blood supply* ; Male ; Middle Aged ; Myocardial Reperfusion Injury/blood ; Myocardial Reperfusion Injury/etiology ; Myocardial Reperfusion Injury/prevention & control ; Prospective Studies ; Republic of Korea ; Time Factors ; Treatment Outcome
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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022522310013334
DOI
10.1016/j.jtcvs.2010.11.018
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Jong Chan(김종찬)
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93322
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