Ischemic Preconditioning to Prevent Acute Kidney Injury
| Status: | Completed |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease, Hospital |
| Therapuetic Areas: | Nephrology / Urology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/17/2018 |
| Start Date: | June 2014 |
| End Date: | February 2016 |
The purpose of this study is to learn about the impact of ischemic preconditioning in
reducing contrast induced kidney damage in people with pre-existing kidney problems who are
undergoing cardiac catheterization procedures.
reducing contrast induced kidney damage in people with pre-existing kidney problems who are
undergoing cardiac catheterization procedures.
Ischemic preconditioning is thought to work by down-regulating pro-inflammatory gene
expression and up-regulating anti-inflammatory gene expression in leukocytes. There is a
local release of vasodilators, including adenosine and nitric oxide that are thought to have
renal protective effects [16]. More is known regarding ischemic preconditioning in the heart,
where it has been shown to decrease the adenine nucleotide pool, increase creatine phosphate
and intracellular glucose, decrease ATP depletion, and lactate and H+ accumulation. This
leads to sodium maintenance of the transmembrane sodium gradient that prevents intracellular
edema. Ischemic preconditioning is thought to yield protection in the first minutes of
reperfusion. Activation of the adenosine A1, bradykinin, and opioid receptors is thought to
trigger protection. This is supported by the interference with protection if an adenosine
receptor antagonist is administered. The role of reactive oxygen species as part of the
protective mechanism has also been described via mitochondrial mKATP channels which lead to
increased production of protective superoxide. Protein kinase C may also be involved in the
protective mechanism of ischemic preconditioning, however the exact mechanism is unknown and
controversial.
expression and up-regulating anti-inflammatory gene expression in leukocytes. There is a
local release of vasodilators, including adenosine and nitric oxide that are thought to have
renal protective effects [16]. More is known regarding ischemic preconditioning in the heart,
where it has been shown to decrease the adenine nucleotide pool, increase creatine phosphate
and intracellular glucose, decrease ATP depletion, and lactate and H+ accumulation. This
leads to sodium maintenance of the transmembrane sodium gradient that prevents intracellular
edema. Ischemic preconditioning is thought to yield protection in the first minutes of
reperfusion. Activation of the adenosine A1, bradykinin, and opioid receptors is thought to
trigger protection. This is supported by the interference with protection if an adenosine
receptor antagonist is administered. The role of reactive oxygen species as part of the
protective mechanism has also been described via mitochondrial mKATP channels which lead to
increased production of protective superoxide. Protein kinase C may also be involved in the
protective mechanism of ischemic preconditioning, however the exact mechanism is unknown and
controversial.
Inclusion Criteria:
- Stage III-IV chronic kidney disease (with serum creatinine at or above 1.4 mg/dl and
eGFR 15-55 ml/min/1.73m2 calculated by the Modification of Diet in Renal Disease
formula)
- Undergoing planned coronary angiography (including both cardiac and peripheral
vascular) and/or intervention at KUMC
Exclusion Criteria:
- Patients with normal renal function (stage 0 to 2 chronic kidney disease and/or serum
creatinine less than 1.4 mg/dl)
- Inability or unwillingness to provide consent
- Patients undergoing hemodialysis or peritoneal dialysis therapy
- Patients with renal artery stenting
- Hemodynamically unstable patients
- Patients with acute or acute on chronic heart failure
- Patients who are unable to undergo the study procedure due to any upper extremity
problems such as prior amputation, prior radical mastectomy, etc
- Patients who have not been hydrated prior to procedure using the standard protocols
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