A prospective randomized trial of remote renal ischemic preconditioning for reducing nephropathy risk following fenestrated endovascular aortic aneurysm repair.

Abstract

We sought to evaluate whether remote renal ischemic preconditioning is effective for reducing postoperative acute kidney injury (AKI) and mid-term renal function decline in patients undergoing elective fenestrated endovascular aneurysm repair (FEVAR) of juxtarenal aortic aneurysms. We performed a single-site, blinded, prospective randomized trial of a renal ischemic preconditioning intervention using arm ischemia via manual inflation of arm blood pressure cuff. We evaluated 30-day AKI, determined using the Risk, Injury, Failure, loss of Function, and End-stage (RIFLE) classification and 2-year freedom from renal function decline, defined as a >30% decrease in baseline estimated glomerular function rate. The study was powered to detect a >25% difference in renal injury incidence. We enrolled 80 patients (80% male; mean aneurysm diameter, 6.1 cm) who were undergoing elective FEVAR using Cook ZFEN devices between July 2018 and August 2023. The 30-day follow-up rate was 95.0%, and mean follow-up duration was 20.2 ± 14.6 months. Although there was a trend to older patient age in the treatment group (77.4 ± 7.8 years vs 74.1 ± 7.0 years), this difference did not reach statistical significance (P = .05). The mean baseline estimated glomerular function rate and creatinine were 69.8 ± 21.0 mL/min/1.73 m² and 1.1 ± 0.4 mg/dL respectively, and 30.0% had chronic kidney disease stage ≥3. There were no differences in any other baseline or operative metrics between the groups. The rate of AKI at 30 days was 11.3% overall (risk, 7.5%; injury, 2.5%; failure, 1.3%) and did not differ between groups. There were no 30-day deaths. There was no difference in 2-year freedom from renal function decline between treatment groups (56.2% vs 81.1%; log-rank P = .12). Renal ischemic preconditioning using arm ischemia did not confer a 30-day AKI or mortality or long-term renal protection benefit in patients undergoing elective FEVAR.