• Yi Yang, Xia-Bing Lang, Ping Zhang, Rong Lv, Yong-Fei Wang, and Jiang-Hua Chen.
• Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
• Am. J. Kidney Dis. 2014 Oct 1;64(4):574-83.

BackgroundRemote ischemic preconditioning (RIPC) to prevent acute kidney injury (AKI) following cardiac and vascular interventions is a controversial practice.Study DesignWe conducted a systematic review and meta-analysis using the MEDLINE database (1966 through November 2013), EMBASE (1988 through November 2013), and Cochrane Library database.Setting & PopulationPatients undergoing cardiac and vascular interventions.Selection Criteria For StudiesRandomized controlled trials comparing patient outcome with or without RIPC for prevention of AKI following cardiac and vascular interventions.InterventionRIPC using an inflatable tourniquet around the limb or cross-clamping the iliac arteries versus non-RIPC.OutcomesAKI, need for renal replacement therapy, postoperative kidney biomarkers, in-hospital mortality, and length of intensive care unit and hospital stay.Results13 trials (1,334 participants) were included. RIPC decreased the risk of AKI for patients undergoing cardiac and vascular interventions compared with the control group (11 trials; 1,216 participants; risk ratio [RR], 0.70; 95% CI, 0.48-1.02; P = 0.06; I(2) = 45%) with marginal statistical significance. There were no differences in levels of postoperative kidney biomarkers (serum creatinine and glomerular filtration rate), incidence of renal replacement therapy, in-hospital mortality, hospital stay, or intensive care unit stay between the 2 groups. Metaregression analysis indicated that contrast intervention was not a covariate contributing significantly to heterogeneity on the risk estimate for AKI incidence; also, there was no dose effect of RIPC using tourniquet cuff around the limb on AKI prevention based on different ischemia duration.LimitationsDifferent AKI definitions adopted in the trials included.ConclusionsRIPC might be beneficial for the prevention of AKI following cardiac and vascular interventions, but the current evidence is not robust enough to make a recommendation. Adequately powered trials are needed to provide more evidence in the future.Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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