Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Effects of Remote Ischemic Pre-Conditioning to Prevent Contrast-Induced Nephropathy after Intravenous Contrast Medium Injection: A Randomized Controlled Trial

  • Dihia Belabbas (Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou) ;
  • Caroline Koch (Department of Radiodology, Toulouse University Hospital) ;
  • Segolene Chaudru (Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou) ;
  • Mathieu Lederlin (Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou) ;
  • Bruno Laviolle (Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou) ;
  • Estelle Le Pabic (Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou) ;
  • Dominique Boulmier (Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou) ;
  • Jean-Francois Heautot (Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou) ;
  • Guillaume Mahe (Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou)
  • Received : 2019.12.06
  • Accepted : 2020.03.31
  • Published : 2020.11.01
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Abstract

Objective: We aimed to assess the effects of remote ischemic pre-conditioning (RIPC) on the incidence of contrast-induced nephropathy (CIN) after an intravenous (IV) or intra-arterial injection of contrast medium (CM) in patient and control groups. Materials and Methods: This prospective, randomized, single-blinded, controlled trial included 26 patients who were hospitalized for the evaluation of the feasibility of transcatheter aortic valve implantation and underwent investigations including contrast-enhanced computed tomography (CT), with Mehran risk scores greater than or equal to six. All the patients underwent four cycles of five minute-blood pressure cuff inflation followed by five minutes of total deflation. In the RIPC group (n = 13), the cuff was inflated to 50 mm Hg above the patient's systolic blood pressure (SBP); in the control group (n = 13), it was inflated to 10 mm Hg below the patient's SBP. The primary endpoint was the occurrence of CIN. Additionally, variation in the serum levels of cystatin C was assessed. Results: One case of CIN was observed in the control group, whereas no cases were detected in the RIPC group (p = 0.48, analysis of 25 patients). Mean creatinine values at the baseline, 24 hours after injection of CM, and 48 hours after injection of CM were 88 ± 32 μmol/L, 91 ± 28 μmol/L and 82 ± 29 μmol/L, respectively (p = 0.73) in the RIPC group, whereas in the control group, they were 100 ± 36 μmol/L, 110 ± 36 μmol/L, and 105 ± 34 μmol/L, respectively (p = 0.78). Cystatin C values (median [Q1, Q3]) at the baseline, 24 hours after injection of CM, and 48 hours after injection of CM were 1.10 [1.08, 1.18] mg/L, 1.17 [0.97, 1.35] mg/L, and 1.12 [0.99, 1.24] mg/L, respectively (p = 0.88) in the RIPC group, whereas they were 1.11 [0.97, 1.28] mg/L, 1.13 [1.08, 1.25] mg/L, and 1.16 [1.03, 1.31] mg/L, respectively (p = 0.93), in the control group. Conclusion: The risk of CIN after an IV injection of CM is very low in patients with Mehran risk score greater than or equal to six and even in the patients who are unable to receive preventive hyperhydration. Hence, the Mehran risk score may not be an appropriate method for the estimation of the risk of CIN after IV CM injection.

Keywords

Acknowledgement

This work was supported by the Societe Francaise de Medecine Vasculaire (SFMV) and the CHU Rennes (AO CORECT 2014).

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