Peer Mohamed, Anil Thomas, Bagialakshmi Gopal
BACKGROUND Acute kidney injury following administration of iodinated contrast (CI-AKI) has been referred to as contrast induced nephropathy (CIN). Ischemic preconditioning (IPC), transient brief episodes of ischemia before a subsequent prolonged ischemia/reperfusion injury, has been shown to reduce the extent of organ damage. Several studies have demonstrated the tissue-protective effects of remote ischemic preconditioning (RIPC) in various target organs, including the kidneys. The aim of this study is to assess if remote ischemic preconditioning reduces the incidence of contrast induced AKI in patients with STEMI undergoing coronary angiogram. MATERIALS AND METHODS The study was conducted in 100 patients (50 cases and 50 control) who were undergoing coronary angiogram (CAG) following acute ST elevation myocardial infarction in Govt. Rajaji Medical College, Madurai. Test group underwent RIPC (Remote Ischemic preconditioning) and control group underwent sham preconditioning prior to procedure whereas both test and control groups received normal saline infusion- 1 ml/kg/hr, beginning 12 hours before CAG till 12 hours after coronary angiogram (CAG). Both groups were followed with serial renal function tests for next 72 hrs after CAG. RESULTS Of the 50 patients in the control group, 18 developed CI-AKI and of the 50 patients in the test group 8 developed CI-AKI (36% vs. 16%). This shows that RIPC was associated with a lower incidence of CI-AKI and the difference was statistically significant. (p=0.040). CONCLUSION Not only was the incidence of CI-AKI lower in the RIPC group, the mean rise in serum creatinine was also lower which would further decrease the duration of hospital stay and short-term mortality. Thus, RIPC can serve as a cost-efficient tool in the lowering of occurrence of CI-AKI in patients undergoing contrast imaging.
