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

Abstract

Objectives: 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 repair (fEVAR) of juxtarenal aortic aneurysms.

Methods: 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 RIFLE classification (risk, injury, failure, loss of function, and end-stage) and 2-year freedom-from renal function decline, defined as >30% decline in baseline estimated glomerular function (eGFR). The study was powered to detect a >25% difference in renal injury incidence.

Results: We enrolled 80 patients (80% male, mean aneurysm diameter 6.1cm), 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. While 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 eGFR and creatinine were 69.8 ± 21.0 mL/min/1.73m² 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 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),.

Conclusions: 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.