The Protective Effect of Remote Ischemic Preconditioning on Acute Kidney Injury Following Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis.

Cardiac surgery in children is a major risk factor for acute kidney injury (AKI) because of the high risk of AKI due to the combination of hemodynamic instability, ischemia-reperfusion injury, and inflammation. However, the protective role of remote ischemic preconditioning (RIPC) in this setting is unclear. This systematic review and meta-analysis was conducted to assess whether RIPC reduces the incidence of AKI in pediatric cardiac surgery patients. PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) of RIPC in pediatric cardiac surgery. The primary outcome indicator was the incidence of postoperative AKI, and secondary outcome indicators included serum creatinine (sCr) level, tumor necrosis factor (TNF)-α level, and intensive care unit (ICU) length of stay (LOS). Six RCTs with a total of 1,098 patients were included in the analysis. RIPC significantly reduced the incidence of AKI (odds ratio, 0.38; 95% confidence interval, 0.25-0.60; p < 0.00001; I² = 38%). There was no significant effect on postoperative sCr, TNF-α levels and ICU LOS (p > 0.05 for all; I² >80%). Sensitivity analyses showed a large impact of some studies on the results. The data indicate that RIPC significantly reduced the incidence of AKI after pediatric cardiac surgery, showing its potential renoprotective effect. Although the effect on other postoperative indicators was not significant, high heterogeneity limits the certainty of the conclusions. Future studies should focus on multicenter, large-scale trials with detailed subgroup analyses to explore the mechanism of action and effects of RIPC in different patient populations.