Remote ischemic preconditioning (RIPC), elicited by brief episodes of ischemia and reperfusion in distant tissue, offers a protection against acute kidney injury (AKI) in patients after cardiac surgery. Investigators conducted a prospective, randomized, controlled clinical trial to assess whether RIPC reduces the incidence of AKI measured by standard way using serum creatinine concentration (SCr) and with use of serum level of neutrophil gelatinase-associated lipocalin (NGAL) as a new potential biomarker of a kidney injury. Moreover the aim of investigation was to analyse the safety and clinical outcomes of RIPC after elective, isolated, primary off-pump coronary artery bypass graft surgery (OPCAB).
Cardiac surgery patients have a high risk of AKI. The development of AKI is associated with higher mortality and a higher risk for complications in patients undergoing cardiac surgery. However, there are no effective clinical strategies for preventing prevalence of AKI. RIPC as a simple, inexpensive way of protecting tissues against ischemic damage, may also reduce kidney injury. That makes RIPC under the area of interests of many researches which apply this method to prevent AKI. Investigators conducted a single-center, double-blind trial involving patients at high risk of postoperative AKI, in which want to check wether RIPC reduce the prevalence of AKI, according Kidney Disease: Improving Global Outcomes (KDIGO) definition, by increase in SCr. Furthermore researchers want to investigate a benefit from RIPC in reduction of level of SCr and higher glomerular filtration rate (GFR) 72 hours after off-pump coronary artery bypass as well as reduction of postoperative expression of NGAL an early biomarker of AKI.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
50
The remote ischemic preconditioning protocol described before began after anesthesia induction, and was completed prior to the start of surgery.
The sham - remote ischemic preconditioning protocol described before began after anesthesia induction, and was completed prior to the start of surgery.
Intensive Cardiac Therapy Clinic
Lodz, Poland
incidence of acute kidney injury within 72 hours after cardiac surgery
increase in serum creatinine level by more than 50% or more than 0.3mg/dL from baseline within 72 h after surgery
Time frame: 72 hours after cardiac surgery
NGAL level
increased NGAL level within 3 hours after cardiac surgery
Time frame: 3 hours after cardiac surgery
length of hospitalization
time until discharge from the hospital
Time frame: through hospitalization completion, an average of 14 days
length of intensive care unit (ICU) stay
time until discharge from ICU
Time frame: through ICU stay completion, an average of 5 days
ventilation time
time of mechanical ventilation
Time frame: through ICU stay completion, an average of 5 days
occurrence of postoperative atrial fibrillation
incidence of atrial fibrylation in continous electrocardiogram registration
Time frame: through ICU stay completion, an average of 5 days
time of renal replacement therapy
days of renal replacement therapy
Time frame: through ICU stay completion, an average of 5 days
death
death from any cause
Time frame: from date of randomization until the date of death from any cause, assessed up to 2 years
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