P65 Remote Ischaemic Preconditioning Reduces Kidney Injury in Vascular Surgery

Abstract

Background

Perioperative acute kidney injury has been found to occur in 12% of patients undergoing lower limb revascularisation (Arora et al., 2013). The aim of the current double-blinded, randomised and shamcontrolled pilot study was to determine the effect of remote ischaemic preconditioning (RIPC) in perioperative renal damage in vascular surgery. Methods: Patients undergoing elective lower limb revascularisation surgery between January 2016 and February 2018, who gave full informed consent, were recruited. Four episodes of 5 minutes of upper limb ischaemia were performed preoperatively. In the sham group, pressure equal to venous pressure was applied instead of ischaemia. Blood samples were collected preoperatively and 20–28 hours after surgery.

Results

Twenty-nine patients were enrolled in the sham and 28 patients were enrolled in the experimental group. The baseline characteristics did not differ between the groups except for gender (Table). The surgery resulted in significant increase of creatinine (from the median value of 80 to 88, p = 0.0279) in the sham group. In the RIPC group, in contrast, significant decline in creatinine (from the mean value of 79 to 75, p = 0.034) and cystatin C (from the median value of 1.1 to 0.9, p = 0.0007) was noted. However, changes in creatinine, urea, cystatin C and B2M between the groups were statistically significant (p-values 0.002, 0.0203, 0.0113, 0.0286 respectively) (Figure).

Conclusion

This pilot study demonstrates that RIPC reduces the levels of biomarkers of acute kidney injury in patients undergoing surgical lower limb revascularisation. This phenomenon may offer renoprotection during vascular surgery.