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Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Crit+Care+Med 2016 ; 44 (3): 607-16 Nephropedia Template TP
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Remote ischemic preconditioning and protection of the kidney - a novel therapeutic option #MMPMID26496454
Zarbock A; Kellum J
Crit Care Med 2016[Mar]; 44 (3): 607-16 PMID26496454show ga
Objective: Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with increased morbidity and mortality. Sepsis, major surgery, and nephrotoxic drugs are the most common causes of AKI. There is currently no effective strategy available to prevent or treat AKI. Therefore, novel treatment regimens are required to decrease AKI incidence and to improve clinical outcomes. Remote ischemic preconditioning (RIPC), triggered by brief episodes of ischemia and reperfusion applied in distant tissues or organs before injury of the target organ, attempts to invoke adaptive responses that protect against AKI. We sought to evaluate the clinical evidence for remote ischemic preconditioning as a potential strategy to protect the kidney, and to review the underlying mechanisms in light of recent studies. Data Sources: We searched PubMed for studies reporting the effect of RIPC on kidney function in surgical patients (search terms: ?remote ischemic preconditioning? and ?kidney function? and ?surgery?). We also reviewed bibliographies of relevant papers to identify additional citations. Study Selection: Published studies, consisting of randomized controlled trials, are reviewed. Data Extraction: The authors used consensus to summarize the evidence behind the use of remote ischemic preconditioning. Data Synthesis: In addition, the authors suggest patient populations and clinical scenarios in which RIPC might be best applied. Conclusions: Several experimental and clinical studies have shown tissue-protective effects of RIPC in various target organs, including the kidneys. RIPC may offer a novel, non-invasive and inexpensive treatment strategy for decreasing AKI incidence in high risk patients. Although many new studies have further advanced our knowledge in this area, the appropriate intensity of RIPC, its mechanisms of action, and the role of biomarkers for patient selection and monitoring are still unknown.