JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2019 Month : March Volume : 6 Issue : 9 Page : 680-683

A STUDY TO ASSESS THE EFFECTIVENESS OF REMOTE ISCHEMIC PRECONDITIONING IN PREVENTING CONTRAST INDUCED ACUTE KIDNEY INJURY IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION UNDERGOING CORONARY ANGIOGRAM

Peer Mohamed1, Anil Thomas2, Bagialakshmi Gopal3

Corresponding Author:
Dr. Peer Mohamed,
Habiba Speciality Hospital,
Vivekanandar Main Road,
Thasildar Nagar,
Madurai- 625020, Tamil Nadu.
E-mail: peermdsh@gmail.com
DOI: 10.18410/jebmh/2019/142

ABSTRACT
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.

KEYWORDS
Contrast Induced Nephropathy, Remote Ischemic Preconditioning, Renal Tubular Cell Injury.