Objectives: In some studies, the nephroprotective effect of ischemic preconditioning (IP) in angiography in patients with coronary heart disease (CHD) and chronic kidney disease (CKD) was shown, however, not for patients with mild creatinine clearance decrease. Aim. To study nephroprotective effects of IP in planned coronarophraphy in patients with CKD stage I-II.
Methods: In randomized, sham-controlled blind study 51 patient with CHD and CKD and creatinine clearance <80 ml/min/m2 expecting coronaroangiography were investigated. Patients were randomized for remote IP or remote sham IP (sIP). Remote IP was accomplished 40-50 min prior to angiography by performing 3 cycles of alternating 5-minute inflation and 5-minute deflation of standard upper-arm BP cuff to the individual’s systolic BP plus 50 mm Hg. Sham IP was performed in the same way as IP, by inflating an upper-arm BP cuff to diastolic pressure to maintain nonischemic upper-arm compression for blinding purposes. Before and after 3 days after the procedure blood serum some kidney markers were investigated: creatinine, urine, NGAL and cystatin-C. The primary endpoint was the development of contrast-induced nephropathy (KIN) and secondary – the increase of markers.
Results: 26 patients were randomized for IP (60.5±1.95), and 25 – for sIP (62.96±1.72). In sIP KIN was in 28% of cases, and in IP – only in 3.8%. All 4 markers have the trend to increase in sIP and decrease in IP (p<0.05).