Remote ischemic preconditioning to prevent cardiac surgery-related acute kidney injury: how far away from a breakthrough?

Many patients undergoing cardiac surgery have pre-existent renal dysfunction or are at least burdened with specific risk factors for developing acute kidney injury (AKI). Additionally, they (may) become exposed to a myriad of renal “insults” during the peri-operative period, including the cardiopulmonary bypass (CPB) and aortic cross-clamping procedure, poly-transfusion, vasopressor and inotropic treatment, and the use of particular colloid or crystalloid solutions (1). Various culprit mechanisms are implicated in the development of cardiac surgery-related AKI (CS-AKI), including systemic inflammation, ischemia-reperfusion injury, enhanced oxidative stress, altered renal perfusion, and acute tubular damage (2). As a result, up to 30% of patients develop CS-AKI and no interventions investigated so far have been shown to reduce this risk (3).