Blood flow conditioning cuts kidney injury

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Remote ischaemic preconditioning, which involves alternately inflating and deflating a blood pressure cuff around a limb to restrict and restore blood flow, reduces kidney injury and the need for dialysis in high risk patients undergoing cardiac surgery, a study reported in JAMA has shown.1

As many as 30% of patients develop acute kidney injury after cardiac surgery, and no interventions investigated so far have been shown to reduce this risk. Research has shown that remote ischaemic preconditioning from brief episodes of ischaemia and reperfusion in distant tissue may protect against subsequent injury. Researchers tested this approach in a study of 240 patients at high risk for acute kidney injury—based on patient characteristics, comorbidities, and type of surgery—who were undergoing cardiac surgery at four hospitals in Germany.

Patients were randomly assigned to remote ischaemic preconditioning with three cycles of five minutes of ischaemia and five minutes of reperfusion or to a sham procedure, both using a cuff around an upper arm after induction of anaesthesia.

Results showed that notably fewer patients given remote ischaemic preconditioning developed acute kidney injury within 72 hours after surgery than those who had the sham procedure (37.5% v 52.5%; absolute risk reduction 15% (95% confidence interval 2.56% to 27.44%); P=0.02).

Fewer patients who underwent remote ischaemic preconditi...