Remote Ischemic Preconditioning as a New Method of Nephroprotection

Not Applicable

Completed

Interventions: Procedure: remote ischemic preconditioning
Procedure: no - remote ischemic preconditioning

Brief Summary: Remote ischemic preconditioning (RIPC), elicited by brief episodes of ischemia and reperfusion in distant tissue, offers a protection against acute kidney injury (AKI) in patients after cardiac surgery. Investigators conducted a prospective, randomized, controlled clinical trial to assess whether RIPC reduces the incidence of AKI measured by standard way using serum creatinine concentration (SCr) and with use of serum level of neutrophil gelatinase-associated lipocalin (NGAL) as a new potential biomarker of a kidney injury. Moreover the aim of investigation was to analyse the safety and clinical outcomes of RIPC after elective, isolated, primary off-pump coronary artery bypass graft surgery (OPCAB).

Detailed Description: Cardiac surgery patients have a high risk of AKI. The development of AKI is associated with higher mortality and a higher risk for complications in patients undergoing cardiac surgery. However, there are no effective clinical strategies for preventing prevalence of AKI. RIPC as a simple, inexpensive way of protecting tissues against ischemic damage, may also reduce kidney injury. That makes RIPC under the area of interests of many researches which apply this method to prevent AKI. Investigators conducted a single-center, double-blind trial involving patients at high risk of postoperative AKI, in which want to check wether RIPC reduce the prevalence of AKI, according Kidney Disease: Improving Global Outcomes (KDIGO) definition, by increase in SCr. Furthermore researchers want to investigate a benefit from RIPC in reduction of level of SCr and higher glomerular filtration rate (GFR) 72 hours after off-pump coronary artery bypass as well as reduction of postoperative expression of NGAL an early biomarker of AKI.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Patients with RIPC	remote ischemic preconditioning	intervention: remote ischemic preconditioning - three cycles of 5-min ischemia, achieved by inflation of blood-pressure cuff to 200 mmHg, followed by 5-min reperfusion while the cuff was deflated were applied to the upper left arm.
Patients without RIPC	no - remote ischemic preconditioning	intervention: no - remote ischemic preconditioning - in controls, the cuff was placed around the arm but not inflated.

Primary Outcome Measures

Name	Time	Method
incidence of acute kidney injury within 72 hours after cardiac surgery	72 hours after cardiac surgery	increase in serum creatinine level by more than 50% or more than 0.3mg/dL from baseline within 72 h after surgery
NGAL level	3 hours after cardiac surgery	increased NGAL level within 3 hours after cardiac surgery

Secondary Outcome Measures

Name	Time	Method
occurrence of postoperative atrial fibrillation	through ICU stay completion, an average of 5 days	incidence of atrial fibrylation in continous electrocardiogram registration
ventilation time	through ICU stay completion, an average of 5 days	time of mechanical ventilation
length of hospitalization	through hospitalization completion, an average of 14 days	time until discharge from the hospital
length of intensive care unit (ICU) stay	through ICU stay completion, an average of 5 days	time until discharge from ICU
time of renal replacement therapy	through ICU stay completion, an average of 5 days	days of renal replacement therapy
death	from date of randomization until the date of death from any cause, assessed up to 2 years	death from any cause