Remote Ischemic Preconditioning for Prevention of Contrast-Associated Acute Kidney Injury following Coronary Angiography or Percutaneous Coronary Intervention

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KEY POINTS: Remote ischemic preconditioning reduced the risk of contrast-associated AKI in patients undergoing coronary angiography or percutaneous coronary intervention. The benefits of remote ischemic preconditioning were consistent across coronary angiography, percutaneous coronary intervention, diabetes, and CKD subgroups. Remote ischemic preconditioning probably reduced in-hospital major adverse cardiovascular events, although there was no significant impact on 30-day kidney and cardiac outcomes. BACKGROUND: Remote ischemic preconditioning may prevent contrast-associated AKI and have cardioprotective effects in patients undergoing coronary angiographic procedures; however, results have been inconsistent. The aim of this systematic review and meta-analysis was to evaluate whether remote ischemic preconditioning lowers the risk of contrast-associated AKI and improves short-term kidney and cardiac outcomes in patients undergoing coronary angiography or percutaneous coronary intervention (PCI). METHODS: We performed a comprehensive literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception through December 6, 2025. Randomized controlled trials (RCTs) comparing remote ischemic preconditioning with either sham remote ischemic preconditioning or usual care for kidney and/or cardiac outcomes in patients undergoing coronary angiography or PCI were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Outcomes studied were contrast-associated AKI, need for dialysis, in-hospital mortality, in-hospital major adverse cardiovascular events (MACE), 30-day mortality, 30-day MACE, and major adverse kidney events at 30 days. Data were pooled using a random-effects model and expressed as risk ratios (RR) with 95% confidence intervals (CI). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Of the 5532 records identified, 36 RCTs encompassing 10,923 patients were included in this systematic review. Compared with sham remote ischemic preconditioning or usual care, remote ischemic preconditioning significantly reduced contrast-associated AKI (RR, 0.54; 95% CI, 0.45 to 0.65; 30 RCTs, 5078 participants; high-certainty evidence). Remote ischemic preconditioning probably reduced in-hospital MACE (RR, 0.51; 95% CI, 0.26 to 0.98; four RCTs, 1266 participants; moderate-certainty evidence). There were no differences in the need for dialysis, in-hospital mortality, 30-day mortality, and 30-day MACE. CONCLUSIONS: Remote ischemic preconditioning reduced the risk of contrast-associated AKI and in-hospital MACE in patients undergoing coronary angiography or PCI.

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