Renal Function and Efficacy of Remote Ischemic Conditioning in Acute Moderate Ischemic Stroke: A Post Hoc Analysis of RICAMIS Trial.

Background: Emerging evidence supports the therapeutic potential of remote ischemic conditioning (RIC) in acute stroke management. This post hoc analysis aims to elucidate the relationship between renal function and the efficacy of RIC.

Methods: This post hoc analysis utilized the complete case dataset from the RICAMIS trial, enrolling acute ischemic stroke patients with documented renal function within 48 h of symptom onset. Participants were categorized into three groups based on their estimated glomerular filtration rate (eGFR) at admission: normal (≥ 90 mL/min/1.73 m²), mildly impaired (60-89 mL/min/1.73m²), and severely impaired renal function (< 60 mL/min/1.73 m²). The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0-1 at 90 days. We examined the association between RIC and functional outcomes within each renal function group, as well as the interaction between RIC efficacy and renal function, in comparison to patients receiving standard care.

Results: Of the 1652 patients evaluated, 941 had normal renal function, 605 had mildly impaired renal function, and 106 had moderate to severely impaired renal function. In comparison to the control group, RIC was associated with a higher probability of achieving the primary outcome in patients with normal renal function (69% vs. 64%) and those with mildly impaired renal function (66.7% vs. 59.7%). However, this association was not observed in patients with moderate to severely impaired renal function (64.1% vs. 66%, p = 0.428). There was no significant interaction between renal function and the efficacy of RIC (adjusted p value = 0.970).

Conclusion: Compared with moderate to severely impaired renal function, RIC is associated with an increased likelihood of excellent functional outcome at 90 days in patients with normal and mildly impaired renal function.

Trial registration: ClinicalTrials.gov identifier: NCT03740971.