Contrast medium administration during imaging and therapeutic procedures can cause renal injury, partly due to ischemia. Therefore, we hypothesized that brief ischemia and reperfusion episodes applied at a distant site – multiple balloon inflations and deflations during angioplasty – may serve as a remote-conditioning (RC) stimulus and thereby protect against contrast-induced kidney injury. To test this hypothesis, we (1) utilized cases from a prior study in which patients undergoing emergent angioplasty for ST segment elevation myocardial infarction received either 1–3 balloon inflations (controls) or were ‘conditioned’ with multiple (≧4) inflations, and (2) assessed renal function for 3 days in patients with an estimated glomerular filtration rate (eGFR) of <90 ml/min/1.73 m2 prior to revascularization (mild kidney disease). Both groups displayed increased eGFR at day 1 after angioplasty versus baseline; attributed to in-hospital hydration (control: 77 ± 14 vs. 68 ± 12 ml/min/1.73 m2; p < 0.01; RC: 81 ± 21 vs. 69 ± 12 ml/min/1.73 m2; p < 0.01). In controls, this improvement was transient: eGFR subsequently decreased to 70 ± 14 ml/min/1.73 m2 at day 3 (p < 0.05). In contrast, the RC group (despite receiving 25% more contrast volume) showed no functional decline at day 3 (80 ± 14 ml/min/1.73 m2). These results are consistent with remote ischemic conditioning providing a novel potential approach to attenuate contrast-associated renal injury.

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