The Effect of Remote Ischemic Preconditioning on Serum Creatinine in Patients Undergoing Partial Nephrectomy: A Randomized Controlled Trial

Abstract

Renal function declines after partial nephrectomy due to ischemic reperfusion injury induced by surgical insult or renal artery clamping. The effect of remote ischemic preconditioning (RIPC) on reducing renal injury after partial nephrectomy has not been studied regarding urinary biomarkers. Eighty-one patients undergoing partial nephrectomy were randomly assigned to either RIPC or the control group. RIPC protocol consisted of four cycles of five-min inflation and deflation of a blood pressure cuff to 250 mmHg. Serum creatinine levels were compared at the following time points: preoperative baseline, immediate postoperative, on the first and third days after surgery, and two weeks after surgery. The incidence of acute kidney injury, other surgical complication rates, and urinary biomarkers, including urine creatinine, β-2 microglobulin, microalbumin, and N-acetyl-beta-D-glucosaminidase were compared. Split renal functions measured by renal scan were compared up to 18 months after surgery. There was no significant difference in the serum creatinine level on the first postoperative day (median (interquartile range) 0.87 mg/dL (0.72-1.03) in the RIPC group vs. 0.92 mg/dL (0.71-1.12) in the control group, p = 0.728), nor at any other time point. There was no significant difference in the incidence of acute kidney injury. Secondary outcomes, including urinary biomarkers, were not significantly different between the groups. RIPC showed no significant effect on the postoperative serum creatinine level of the first postoperative day. We could not reveal any significant difference in the urinary biomarkers and clinical outcomes. However, further larger randomized trials are required, because our study was not sufficiently powered for the secondary outcomes.

Keywords: acute kidney injury; partial nephrectomy; remote ischemic preconditioning; urinary biomarker.

Figure 1

Consolidated Standards of Reporting Trials (CONSORT) flowchart.

Figure 2

Comparison of time-dependent changes in the serum creatinine between the RIPC and control groups. Time points were defined as preoperative (T1), at post-anesthesia care unit (T2), postoperative day 1 (T3), postoperative day 3 (T4), and two weeks after surgery (T5).

Figure 3

Comparison of the time-dependent changes in the estimated glomerular filtration rate between the RIPC and control groups. The time points were defined as preoperative (T1), at post-anesthesia care unit (T2), postoperative day 1 (T3), postoperative day 3 (T4), and two weeks after surgery (T5).