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Angiología
On-line version ISSN 1695-2987Print version ISSN 0003-3170
Abstract
GUTIERREZ CASTILLO, Diana; SAN NORBERTO GARCIA, Enrique M and DEL RIO SOLA, Mª Lourdes. Prospective randomized clinical trial on the impact of remote ischemic preconditioning on contrast induced nephropathy in patients treated endovascular aortic repair. Angiología [online]. 2023, vol.75, n.6, pp.362-372. Epub Jan 29, 2024. ISSN 1695-2987. https://dx.doi.org/10.20960/angiologia.00542.
Introduction:
the biggest drawback of using iodinated contrasts in clinical practice is contrast nephropathy, which increases morbidity and mortality and hospital costs. Remote ischemic preconditioning (RIPC) is a non-invasive tissue protection technique that has proven to be able to reduce renal involvement after intravascular contrast administration.
Objective:
the main goal of this study was to assess the impact of RIPC on the incidence of contrast-induced nephropathy in patients undergoing endovascular aortic repair (EVAR).
Material and methods:
patients who underwent elective EVAR were included, and then sequentially assigned to the control and preconditioning groups (groups C and p, respectively). Pre- and postoperative hematocrit (at 24, 72 hours, and 30 days) was analyzed.
Results:
a total of 98.3 % of the patients included in the study were men out of a total sample of 120 patients. The mean age was 73 years (range, 56-87). Diabetes and preoperative chronic kidney disease (understood as glomerular filtration rates < 60 mL/min) were present in 29.16 % and 38.33 % of the patients, respectively. Half of the sample received preconditioning in the preoperative period. A total of 24.17 % of the patients developed nephropathy despite fluid therapy with or without preconditioning. At the postoperative period (24 h-72 h), preconditioning did not modify the incidence rate of nephropathy, serum creatinine and urea, or even the estimated glomerular filtration rate (eGFR). However, at the 30-day follow-up the preconditioned group showed a significant improvement in serum creatinine and urea levels (1.46 ± 0.3 vs 1.03 ± 0.5; p < 0.001; 61.06 ± 27.5 mg/dL vs 43 .78 ± 12.9 mg/dL; p = 0.003) and eGFR increase (56.37 ± 23.4 mL/min/1.73 m2 vs 72.85 ± 17.7mL/min/1.73 m2; p = 0.004).
Conclusions:
RIPC seems effective in alleviating the effects of iodinated contrast on the kidneys of patients undergoing EVAR in the short term follow up (30 days).
Keywords : EVAR; Remote ischemic preconditioning; Contrast induced nephropathy; Intravascular contrast media; Ischemia-reperfusion injury.