Renal protective effect of remote ischemic preconditioning: a meta-analysis of randomized controlled trials

Abstract

Background The incidence of acute kidney injury (AKI) is ∼21.6% in hospitalized patients with an increased incidence of mortality. Although many trials have been done to prevent or treat AKI, most of these efforts have yielded limited success. Objectives This study aimed to detect the effects of remote ischemic preconditioning (RIPC) on the incidence and outcomes of AKI. Study design A meta-analysis was used to address this concern. Settings A meta-analysis-based study following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methods The databases such as MEDLINE, EMBASE, PubMed, and Cochrane were systemically searched to identify all published prospective, randomized, and controlled clinical trials in the last 5 years comparing RIPC with control in different procedures. Results A total of 26 studies were identified for inclusion in this study, involving 3978 patients. The risk of bias was low. Meta-analysis showed that the rate of AKI was significantly lower in the RIPC group, there was no statistically significant difference in the overall mortality, and there was no significant change in serum creatinine value. Regarding serum neutrophil gelatinase-associated lipocalin and estimated glomerular filtration rate, the study favors the RIPC group than the control group. There was no significant difference in the period of hospital stays, whereas the length of ICU stay was remarkably reduced in the RIPC group. Limitations The definitions of AKI adopted in respective trials were different. Comorbidities among the studies that may raise protective threshold were different. In our analysis, preoperative kidney function of the studies was different, and the use of different anesthetic protocols might confound the effect of RIPC. Conclusion RIPC offers a novel, noninvasive, and inexpensive treatment strategy for decreasing AKI incidence and improving the outcome in high-risk patients.