Ischemic Preconditioning for Prevention of Contrast Medium-Induced Nephropathy Randomized Pilot RenPro Trial (Renal Protection Trial)

Background-Contrast medium-induced acute kidney injury is associated with substantial morbidity and mortality. The underlying mechanism has been attributed in part to ischemic kidney injury. The aim of this randomized, double-blind, sham-controlled trial was to assess the impact of remote ischemic preconditioning on contrast medium-induced acute kidney injury. Methods and Results-Patients with impaired renal function (serum creatinine > 1.4 mg/dL or estimated glomerular filtration rate <60 mL.min(-1) . 1.73 m(-2)) undergoing elective coronary angiography were randomized in a 1: 1 ratio to standard care with (n = 50) or without ischemic preconditioning (n = 50; intermittent arm ischemia through 4 cycles of 5-minute inflation and 5-minute deflation of a blood pressure cuff). Overall, both study groups were at high risk of developing contrast medium-induced acute kidney injury according to the Mehran risk score. The primary end point was the incidence of contrast medium-induced kidney injury, defined as an increase in serum creatinine >= 25% or >= 0.5 mg/dL above baseline at 48 hours after contrast medium exposure. Contrast medium-induced acute kidney injury occurred in 26 patients (26%), 20 (40%) in the control group and 6 (12%) in the remote ischemic preconditioning group (odds ratio, 0.21; 95% confidence interval, 0.07-0.57; P=0.002). No major adverse events were related to remote ischemic preconditioning. Conclusions-Remote ischemic preconditioning before contrast medium use prevents contrast medium-induced acute kidney injury in high-risk patients. Our findings merit a larger trial to establish the effect of remote ischemic preconditioning on clinical outcomes. Clinical Trial Registration-URL: http://www.germanctr.de.Unique identifier: U1111-1118-8098. (Circulation. 2012; 126: 296-303.)