Remote Ischemic Perconditioning Reduces Actue Kidney Injury In Adult Valve Replacement

Objectives:The recent studies suggest that remote ischemic perconditioning reduces myocardial infarction and improves ventricular function in vivo. This study aims to determine the protection of remote ischemic perconditioning against actue kidney injury in patients undergoing valve replacement.Methods:One hundred and four patients admitted for selective valve replacement were divided into2groups randomly. Control group (CON. n=53) underwent placement of the tourniquet around the left thigh without inflation; the remote perconditioning group (R-Per. n=51) received3cycles of5/5minutes left thigh ischemia and reperfusion after aortic cross-clamping, the limb ischemia was induced by the tourniquet inflated to600mmHg. Blood platelet and hemoglobin (Hb) were measured preoperatively and24h after aortic de-clamping. Venous blood samples were obtained preoperatively,24h and48h after aortic de-clamping for detecting serum creatinine (scr) and blood urea nitrogen (BUN) concentration.Venous blood samples were obtained preoperatively,12h,24h and48h after aortic de-clamping for detecting Cystatin C(cysC)、high-sensitivity C-reactive protein (CRP-hs) concentration. Urine N-b-beta D-amino glycosidase enzymes (NAG) was measured preoperatively6h、12h、24h and48h after aortic de-clamping. The CPB time, aortic clump time, perfusion mean arterial pressure, and spontaneous resuscitation, ultrafiltration, inotropes requirement, mechanical ventilation time, intensive care time,24h infusion quantity,24h drainage,24h urine volume, length of hospital stay, and major complications were routinely recorded. All patients were followed up for30days after operation.Statistical analysis:Statistical analysis was performed with the SPSS statistical software, SPSS PASW Statistics. Categorical data were analyzed using chi-square test. Measurement data were compared by one-way analysis of variance. The continuous variables were analyzed with repeated-measures analysis of variance. A value ofp<0.05was regarded as significant.Results:The Scr levels at48h after aortic de-clamping was significantly lower in the remote ischemic perconditioning group (CON. Vs. RIPerC.102.59±38.44vs.86.70±19.38, p=0.009). The remote perconditioning group had significantly lower CRP-hs at24h after aortic de-clamping(CON. Vs. RIPerC.,20.70±2.58vs.19.32±2.79,p=0.020) and48h after aortic de-clamping(CON. Vs. RIPerC.,20.91±2.24vs.19.30±3.02,p=0.006). We observed a significant difference in the drainage(CON. Vs. RIPerC570.3±382.9vs.419.7±254.8ml,p=0.021) during the first24h after surgery between remote ischemic perconditioning and control groups. There were no differences between remote ischemic perconditioning and control groups with respect to BUN、Ccr、cysC、NAG、Plt、Hb (p>0.05). Conclusions:Remote ischemic perconditioning induced by transient low limb ischemia after aortic cross-clamping reduces actue kidney injury in adults patients undergoing selective valve replacement.