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Remote ischemic preconditioning in myocardial protection in hemodialysis patients

Authors Bacci MR, Vasconcelos LY, Murad N, Chagas AC, Capuano AC, Alves BC, Pereira EC, Azzalis LA, Junqueira VB, Fonseca FL

Received 20 June 2017

Accepted for publication 14 November 2017

Published 8 May 2018 Volume 2018:11 Pages 175—178

DOI https://doi.org/10.2147/IJGM.S144385

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser


Marcelo R Bacci,1 Livia Y Vasconcelos,1 Neif Murad,2 Antonio Carlos P Chagas,2 Ana Carolina Capuano,1 Beatriz CA Alves,3 Edimar C Pereira,4 Ligia A Azzalis,4 Virginia BC Junqueira,4 Fernando LA Fonseca3,4

1Department of General Practice, 2Department of Cardiology, 3Clinical Analysis Laboratory of Faculdade de Medicina do ABC, Santo André, SP, Brazil; 4Department of Pharmaceutical Sciences, Universidade Federal de Sao Paulo, Diadema, SP, Brazil


Background:
Remote ischemic preconditioning (RIPC) is a procedure that generates a brief period of ischemia followed by reperfusion. The role of RIPC in protecting myocardial ischemia during hemodialysis is not yet established. The aim of the study was to evaluate RIPC myocardial protection as evaluated by ultrasensitive I troponin in hemodialysis outpatients.
Patients and methods: A double-blind randomized trial with two groups: intervention submitted to RIPC and control group without RIPC. Intervention group received RIPC in three consecutive hemodialysis sessions. Blood samples were taken before and after each session. Blood urea nitrogen for calculation of single-pool Kt/v and ultrasensitive I troponin were measured to evaluate dialysis adequacy and myocardial injury.
Results: A total of 47 patients were randomized. About 60.8% were men and 54% were diabetic. The mean single-pool Kt/v was 1.51 in the intervention group and 1.49 in control. The ultrasensitive troponin I measured no significant change from the time of collection: before or after dialysis.
Conclusion: The RIPC applied in three consecutive sessions did not demonstrate superiority to control, therefore another study tested RIPC in 12 consecutive sessions with a positive result in myocardial protection. In our study, more than half of the patients were diabetic. Diabetic patients have a trend to show a lower response to RIPC because of the greater presence of collateral coronary circulation. In summary, in this model there was no interference of RIPC in ultrasensitive troponin I values, but troponin had a high negative predictive value for myocardial infarction in all tested models.

Keywords: hemodialysis, chronic kidney disease, cardiac troponin, remote ischemic preconditioning, myocardial infarction

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