Hoe een arm de nier kan beschermen

Brief bouts of ischaemia and reperfusion of one organ protect remote organs against a subsequent longer episode of ischaemia and reperfusion. This phenomenon has been termed remote ischaemic preconditioning (RIPC). Preclinical evidence of RIPC protecting the heart and kidney against ischaemia-reperfusion injury is overwhelming. A recent multicentric, randomized, controlled trial in patients undergoing cardiac surgery revealed that RIPC of the upper arm reduced the postoperative rate of acute kidney injury and use of renal replacement therapy. This is in contrast to the lack of effect of RIPC on acute kidney injury in patients undergoing coronary artery bypass surgery in another recent study. The difference might be explained by the selection of patients with a high risk of developing acute kidney injury and the exclusion of co-medication that can interfere with RIPC. A large clinical trial in these selected patients with relevant clinical endpoints is needed before RIPC is used routinely in clinical practice.

Conflict of interest and financial support: ICMJE forms provided by the authors are available online along with the full text of this article.