Effect of remote ischemic preconditioning on the risk of contrast-induced acute kidney injury in patients with coronary heart disease undergoing percutaneous coronary intervention

Contrast-induced acute kidney injury (CIAKI) is a frequent and clinically important complication after percutaneous coronary intervention (PCI). Despite standard preventive strategies including adequate hydration and the use of low- or iso-osmolar contrast media, the residual risk of CIAKI remains substantial. Remote ischemic preconditioning (RIPC), a non-invasive method involving brief cycles of ischemia and reperfusion applied to a limb, has been proposed as a potential strategy to mitigate ischemia–reperfusion injury, including in the kidneys. However, the impact of RIPC on the incidence of CIAKI after PCI in patients with CHD remains unclear. This study aim is to investigate the impact of RIPC on the incidence of CIAKI in patients with CHD undergoing PCI. A total of 484 patients who underwent elective PCI were enrolled and randomly assigned to either the RIPC or control group. The RIPC group received preconditioning twice daily for two days prior to PCI and once again two hours before the procedure. Renal function was assessed at baseline, 48 h, and one week post-PCI. The primary endpoint was the incidence of CIAKI, and the secondary endpoint was the occurrence of major adverse cardiac events (MACE) during the 90-day follow-up. Results showed that the incidence of CIAKI was significantly lower in the RIPC group compared to the control group (6.2% vs. 12.0%, P = 0.039), with multivariate analysis indicating RIPC as an independent protective factor for reducing CIAKI (OR = 0.338, 95% CI: 0.159–0.717, P = 0.005). However, there was no significant difference in the incidence of MACE between the two groups during the follow-up period (Log-rank χ ² = 1.665, P = 0.126).In conclusion, RIPC appears to reduce the risk of CIAKI in patients with CHD after PCI, offering a simple, cost-effective, and non-pharmacological preventive strategy.