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2016 ; 20
(1
): 111
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Protection of remote ischemic preconditioning against acute kidney injury: a
systematic review and meta-analysis
#MMPMID27095379
Hu J
; Liu S
; Jia P
; Xu X
; Song N
; Zhang T
; Chen R
; Ding X
Crit Care
2016[Apr]; 20
(1
): 111
PMID27095379
show ga
BACKGROUND: Remote ischemic preconditioning (RIPC) is a promising approach to
preventing acute kidney injury (AKI), but its efficacy is controversial. METHODS:
A systematic review of 30 randomized controlled trials was conducted to
investigate the effects of RIPC on the incidence and outcomes of AKI. Random
effects model meta-analyses and meta-regressions were used to generate summary
estimates and explore sources of heterogeneity. The primary outcome was incidence
of AKI and hospital mortality. RESULTS: The total pooled incidence of AKI in the
RIPC group was 11.5 %, significantly less than the 23.3 % incidence in the
control group (P = 0.009). Subgroup analyses indicated that RIPC significantly
reduced the incidence of AKI in the contrast-induced AKI (CI-AKI) subgroup from
13.5 % to 6.5 % (P = 0.000), but not in the ischemia/reperfusion-induced AKI
(IR-AKI) subgroup (from 29.5 % to 24.7 %, P = 0.173). Random effects
meta-regression indicated that RIPC tended to strengthen its renoprotective
effect (q = 3.95, df = 1, P = 0.047) in these trials with a higher percentage of
diabetes mellitus. RIPC had no significant effect on the incidence of stages 1-3
AKI or renal replacement therapy, change in serum creatinine and estimated
glomerular filtration rate (eGFR), hospital or 30-day mortality, or length of
hospital stay. But RIPC significantly increased the minimum eGFR in the IR-AKI
subgroup (P = 0.006) compared with the control group. In addition, the length of
ICU stay in the RIPC group was significantly shorter than in the control group
(2.6 vs 2.0 days, P = 0.003). CONCLUSIONS: We found strong evidence to support
the application of RIPC to prevent CI-AKI, but not IR-AKI.
|Acute Kidney Injury/etiology/mortality/*prevention & control
[MESH]