Remote ischemic preconditioning for renal protection during elective open infrarenal abdominal aortic aneurysm repair: Randomized controlled trial

We aimed to determine whether remote ischemic preconditioning (IP) reduces renal damage following elective open infrarenal abdominal aortic aneurysm (AAA) repair. Sequential common iliac clamping was used to induce remote IP in randomized patients. Urinary retinol binding protein (RBP) and albumin-creatinine ratio (ACR) were measured following induction and 3, 24, and 48 hours postoperatively. In controls (n = 22), median urinary RBP increased from 112 μg/mL (interquartile range [IQR] 96-173 μg/mL) preoperatively to 5919 μg/mL (IQR 283-17 788 μg/mL) at 3 hours. Preoperative urinary RBP in preconditioned patients was 96 μg/mL (IQR 50 to 229 μg/mL) preoperatively, rising to 1243 μg/mL (IQR 540 to 15400 μg/mL) at 3 hours. Although control patients' median urinary RBP level was 5 times greater at 3 hours, there were no statistically significant differences in renal outcome indices. This trial could not confirm that remote IP reduces renal injury following elective open aneurysm surgery.