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.