Remote ischemic conditioning for the prevention of contrast-induced acute kidney injury in patients undergoing intravascular contrast administration: a meta-analysis and trial sequential analysis of 16 randomized controlled trials

// Chang-Cheng Zhou 1,* , Wen-Tao Yao 1,* , Yu-Zheng Ge 1 , Lu-Wei Xu 1 , Ran Wu 1 , Xiao-Fei Gao 2 , Kai-Wei Song 1 , Xiao-Min Jiang 2 , Min Wang 1 , Wen-Juan Huang 3 , Yun-Peng Zhu 1 , Liang-Peng Li 4 , Liu-Hua Zhou 1 , Zhong-Le Xu 1,5 , Sheng-Li Zhang 1 , Jia-Geng Zhu 1 , Wen-Cheng Li 1 and Rui-Peng Jia 1 1 Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 2 Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 3 Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 4 Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 5 Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China * These authors have contributed equally to this work Correspondence to: Rui-Peng Jia, email: // Yu-Zheng Ge, email: // Keywords : remote ischemic conditioning, contrast-induced acute kidney injury, randomized controlled trial, meta-analysis, trial sequential analysis Received : December 21, 2016 Accepted : May 12, 2017 Published : May 23, 2017 Abstract Objective: We conducted this meta-analysis to examine the effect of remote ischemic conditioning (RIC) on contrast-induced acute kidney injury (CI-AKI) in patients undergoing intravascular contrast administrationon. Methods: Pubmed, Embase, and Cochrane Library were comprehensively searched to identify all eligible studies by 15th March, 2017. Risk ratio (RR) and weighted mean difference with the corresponding 95% confidence intervals (CI) were used to examine the treatment effect. The heterogeneity and statistical significance were assessed with Q-test and Z-test, respectively. Results: A total of 16 RCTs including 2175 patients were eventually analyzed. Compared with the control group, RIC could significantly decrease the incidence of CI-AKI (RR=0.58; 95% CI: 0.46, 0.74; P < 0.001), which was further confirmed by the trial sequential analysis. Subgroup analyses showed that remote ischemic preconditioning (RIPrC) and remote ischemic postconditioning (RIPoC) were both obviously effective, and perioperative hydration might enhance the efficiency of RIC. RIC also significantly reduced the major adverse cardiovascular events within six months. Conclusion: RIC, whether RIPrC or RIPoC, could effectively exert renoprotective role in intravascular contrast administration and reduce the incidence of relevant adverse events.