SynthesisJournal of the American Society of Nephrology : JASN2026
Remote Ischemic Preconditioning for Prevention of Contrast-Associated Acute Kidney Injury following Coronary Angiography or Percutaneous Coronary Intervention.
Synthesis in Journal of the American Society of Nephrology : JASN, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
key pointsRemote ischemic preconditioning reduced the risk of contrast-associated AKI in patients undergoing coronary angiography or percutaneous coronary intervention. The benefits of remote ischemic preconditioning were consistent across coronary angiography, percutaneous coronary intervention, diabetes, and CKD subgroups. Remote ischemic preconditioning probably reduced in-hospital major adverse cardiovascular events, although there was no significant impact on 30-day kidney and cardiac outcomes.
backgroundRemote ischemic preconditioning may prevent contrast-associated AKI and have cardioprotective effects in patients undergoing coronary angiographic procedures; however, results have been inconsistent. The aim of this systematic review and meta-analysis was to evaluate whether remote ischemic preconditioning lowers the risk of contrast-associated AKI and improves short-term kidney and cardiac outcomes in patients undergoing coronary angiography or percutaneous coronary intervention (PCI).
methodsWe performed a comprehensive literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception through December 6, 2025. Randomized controlled trials (RCTs) comparing remote ischemic preconditioning with either sham remote ischemic preconditioning or usual care for kidney and/or cardiac outcomes in patients undergoing coronary angiography or PCI were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Outcomes studied were contrast-associated AKI, need for dialysis, in-hospital mortality, in-hospital major adverse cardiovascular events (MACE), 30-day mortality, 30-day MACE, and major adverse kidney events at 30 days. Data were pooled using a random-effects model and expressed as risk ratios (RR) with 95% confidence intervals (CI). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
resultsOf the 5532 records identified, 36 RCTs encompassing 10,923 patients were included in this systematic review. Compared with sham remote ischemic preconditioning or usual care, remote ischemic preconditioning significantly reduced contrast-associated AKI (RR, 0.54; 95% CI, 0.45 to 0.65; 30 RCTs, 5078 participants; high-certainty evidence). Remote ischemic preconditioning probably reduced in-hospital MACE (RR, 0.51; 95% CI, 0.26 to 0.98; four RCTs, 1266 participants; moderate-certainty evidence). There were no differences in the need for dialysis, in-hospital mortality, 30-day mortality, and 30-day MACE.
conclusionsRemote ischemic preconditioning reduced the risk of contrast-associated AKI and in-hospital MACE in patients undergoing coronary angiography or PCI.
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