The efficacy of remote ischemic conditioning in preventing contrast‐induced nephropathy among patients undergoing coronary angiography or intervention: An updated systematic review and meta‐analysis

• Published in: Annals of noninvasive electrocardiology Vol. 25; no. 2; pp. e12706 - n/a
• Main Authors: Zhan, Biming, Zhu, Bo, Hu, Jianxin, Huang, Qianghui, Bao, Huihui, Huang, Xiao, Cheng, Xiaoshu
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-03-2020; John Wiley and Sons Inc
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - chemically induced; Acute Kidney Injury - prevention & control; Angiography; Biomarkers - blood; Clinical trials; Conditioning; Confidence intervals; Contrast media; Contrast Media - adverse effects; contrast medium; contrast‐induced nephropathy; Coronary Angiography; diabetes mellitus; Humans; Ischemia; Ischemic Preconditioning - methods; Meta-analysis; Nephropathy; remote ischemic conditioning; Review; Reviews; Risk Factors; Subgroups; Upgrading; contrast-induced nephropathy; remote ischemic conditioning; diabetes mellitus; contrast medium
• ISSN: 1082-720X; 1542-474X
• DOI: 10.1111/anec.12706

Background
Numerous trials have investigated the effect of remote ischemic conditioning (RIC) in preventing contrast‐induced nephropathy (CIN) in patients receiving contrast medium (CM). This meta analysis aims to validate the role of RIC in preventing CIN.
Methods
We searched the PubMed, EMBASE, and Web of Science databases for eligible randomized controlled trials (RCTs) published before April 27, 2019. Two investigators independently extracted basic characteristics from each study. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to examine the treatment effect.
Results
A total of 18 studies comprising 2,503 patients were included in our meta‐analysis. Compared with conventional therapy, RIC significantly reduced the risk of CIN (OR = 0.43, 95% CI: 0.33, 0.56, p < .05). Subgroup analyses showed that the protective effect of RIC was stronger in the low‐osmolar contrast media group (OR = 0.32; 95% CI: 0.23, 0.45, p < .05) and the nondiabetic group (OR = 0.39; 95% CI: 0.29, 0.53 p < .05). RIC also significantly reduced major adverse cardiovascular events within the first 6 months (OR = 0.39; p < .05), but the influence was not present after long‐term follow‐up.
Conclusions
Our meta‐analysis showed that RIC could effectively reduce CIN risk and decrease the short‐term incidence of relevant adverse events. Furthermore, the effects of CIN are more pronounced in nondiabetic patients and with the use of low‐osmolar contrast medium. This meta‐analysis of small trials suggests a possible protective effect of RIC on contrast‐induced nephropathy and favors the performance of a large randomized trial to further investigate this strategy.