Remote-conditioning ischemia provides a potential approach to mitigate contrast medium-induced reduction in kidney function: A retrospective observational cohort study

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 m ² 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 m ²; p < 0.01; RC: 81 ± 21 vs. 69 ± 12 ml/min/1.73 m ²; p < 0.01). In controls, this improvement was transient: eGFR subsequently decreased to 70 ± 14 ml/min/1.73 m ² 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 m ²). These results are consistent with remote ischemic conditioning providing a novel potential approach to attenuate contrast-associated renal injury.