TY - JOUR

T1 - Failure of remote ischemic preconditioning to reduce the risk of postoperative acute kidney injury in children undergoing operation for complex congenital heart disease

T2 - a randomized single-center study

AU - Pedersen, Kirsten Rønholt

AU - Ravn, Hanne Berg

AU - Povlsen, Johan Vestergaard

AU - Schmidt, Michael Rahbek

AU - Erlandsen, Erland Jørn

AU - Hjortdal, Vibeke Elisabeth

N1 - Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

PY - 2012/3

Y1 - 2012/3

N2 - OBJECTIVE: The objective of this study was to evaluate whether remote ischemic preconditioning can protect kidney function in children undergoing operation for complex congenital heart disease.METHODS: Children (n = 113) aged 0 to 15 years admitted for complex congenital heart disease were randomly allocated according to age to remote ischemic preconditioning and control groups. After exclusion of 8 patients, we conducted the analysis on 105 patients (remote ischemic preconditioning group, n = 54; control group, n = 51). Before surgery, remote ischemic preconditioning was performed as 4 cycles of 5 minutes of ischemia by inflating a cuff around a leg to 40 mm Hg above the systolic pressure. End points were development of acute kidney injury, initiation of dialysis, plasma creatinine, estimated glomerular filtration rate, plasma cystatin C, plasma and urinary neutrophil gelatinase-associated lipocalin, and urinary output. Secondary end points included postoperative blood pressure, inotropic score, and mortality, as well as morbidity reflected by reoperation and stays in the intensive care unit and hospital.RESULTS: Overall, 57 of the children (54%) had acute kidney injury develop, with 27 (50%) in the remote ischemic preconditioning group and 30 (59%) in the control group (P > .2). Remote ischemic preconditioning was not associated with improvement in either any of the renal biomarkers or any of the secondary end points.CONCLUSIONS: We found no evidence that remote ischemic preconditioning provided protection of kidney function in children undergoing operation for complex congenital heart disease.

AB - OBJECTIVE: The objective of this study was to evaluate whether remote ischemic preconditioning can protect kidney function in children undergoing operation for complex congenital heart disease.METHODS: Children (n = 113) aged 0 to 15 years admitted for complex congenital heart disease were randomly allocated according to age to remote ischemic preconditioning and control groups. After exclusion of 8 patients, we conducted the analysis on 105 patients (remote ischemic preconditioning group, n = 54; control group, n = 51). Before surgery, remote ischemic preconditioning was performed as 4 cycles of 5 minutes of ischemia by inflating a cuff around a leg to 40 mm Hg above the systolic pressure. End points were development of acute kidney injury, initiation of dialysis, plasma creatinine, estimated glomerular filtration rate, plasma cystatin C, plasma and urinary neutrophil gelatinase-associated lipocalin, and urinary output. Secondary end points included postoperative blood pressure, inotropic score, and mortality, as well as morbidity reflected by reoperation and stays in the intensive care unit and hospital.RESULTS: Overall, 57 of the children (54%) had acute kidney injury develop, with 27 (50%) in the remote ischemic preconditioning group and 30 (59%) in the control group (P > .2). Remote ischemic preconditioning was not associated with improvement in either any of the renal biomarkers or any of the secondary end points.CONCLUSIONS: We found no evidence that remote ischemic preconditioning provided protection of kidney function in children undergoing operation for complex congenital heart disease.

KW - Acute Kidney Injury/blood

KW - Acute-Phase Proteins/urine

KW - Adolescent

KW - Biomarkers/blood

KW - Cardiac Surgical Procedures/adverse effects

KW - Chi-Square Distribution

KW - Child

KW - Child, Preschool

KW - Creatinine/blood

KW - Cystatin C/blood

KW - Denmark

KW - Female

KW - Glomerular Filtration Rate

KW - Heart Defects, Congenital/surgery

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Ischemic Preconditioning/methods

KW - Kidney/metabolism

KW - Likelihood Functions

KW - Lipocalin-2

KW - Lipocalins/urine

KW - Lower Extremity/blood supply

KW - Male

KW - Proto-Oncogene Proteins/urine

KW - Renal Dialysis

KW - Time Factors

KW - Treatment Failure

KW - Urination

U2 - 10.1016/j.jtcvs.2011.08.044

DO - 10.1016/j.jtcvs.2011.08.044

M3 - Journal article

C2 - 21955475

VL - 143

SP - 576

EP - 583

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 3

ER -