Remote Ischemic Pre-Conditioning Alleviates Contrast-Induced Acute Kidney Injury in Patients With Moderate Chronic Kidney Disease
Remote Ischemic Pre-Conditioning Alleviates Contrast-Induced Acute Kidney Injury in Patients With Moderate Chronic Kidney Disease
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DOI：
10.1253/circj.cj-13-0171
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发表时间：
2013-12-01
影响因子：
3.3
通讯作者：
Ito, Hiroshi
中科院分区：
文献类型：
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作者：
Igarashi, Gen;Iino, Kenji;Ito, Hiroshi
背景资料：尽管远程缺血预处理（RIPC）已被证明可以保护造影剂诱导的急性肾损伤（CI-AKI）高风险患者的肾功能，但对低-中度风险患者的影响尚不清楚。RIPC在CI-AKI高危患者中的预防作用进行了检查，并通过RIPC investigated.Methods和结果：60例中度慢性肾脏疾病和接受血管造影的患者被随机分配到对照组（n=30）或RIPC（间歇性手臂缺血，n=30）组的预期作用的生物标志物。两组的基线特征无显著差异。通过测定尿肝型脂肪酸结合蛋白（L-FABP）评价CI-AKI。在血管造影术前、24和48 h后测量生物标志物。血管造影术后24小时，RIPC组尿L-FABP水平的百分比变化显著小于对照组（41.3 +/- 15.6 vs. 159 +/-34.1%，P=0.003）。8名对照患者（26.9%）发生了基于L-FABP的CI-AKI，而RIPC组仅2名患者（7.7%）发生了CI-AKI，表明RIPC可预防CI-AKI。分析CI-AKI的相关因素。无论是高敏C-反应蛋白，也不是pentraxine-3水平显着不同的两组之间，而在不对称二甲基精氨酸（ADMA）水平和血液衍生物的反应性氧化代谢产物水平的百分比变化显着较小的RIPC group.Conclusions：RIPC的CI-AKI患者在低中度风险。这种作用可能部分通过降低氧化应激和血浆ADMA水平来介导。
Background: Although remote ischemic preconditioning (RIPC) is shown to preserve kidney function in patients at high risk of contrast-induced acute kidney injury (CI-AKI), the effect in patients at low-moderate risk remains unknown. The preventive effects of RIPC in patients not at high risk of CI-AKI were examined, and biomarkers with anticipated roles in renal protection via RIPC investigated.Methods and Results: Sixty patients who had moderate chronic kidney disease and who underwent angiography were randomly assigned to the control (n=30) or RIPC (intermittent arm ischemia, n=30) group. The baseline characteristics in the 2 groups did not differ significantly. CI-AKI was evaluated by measuring urinary liver-type fatty acid-binding protein (L-FABP). Biomarkers were measured before and 24 and 48 h after angiography. Twenty-four hours after angiography, the percent change in urinary L-FABP level in the RIPC group was significantly smaller than in the control group (41.3 +/- 15.6 vs. 159 +/- 34.1%, P=0.003). L-FABP-based CI-AKI developed in 8 control patients (26.9%) vs. only 2 patients in the RIPC group (7.7%), suggesting that RIPC prevents CI-AKI. Factors contributing to CI-AKI were analyzed. Neither high-sensitivity C-reactive protein nor pentraxine-3 level differed significantly between the 2 groups, while the percent change in asymmetrical dimethy larginine (ADMA) level and blood derivatives of reactive oxidative metabolite levels were significantly smaller in the RIPC group.Conclusions: RIPC alleviates CI-AKI in patients at low-moderate risk. This effect might be mediated partly by decreasing oxidative stress and plasma ADMA level.