• Alexander Zarbock and John A Kellum.
• 1Department of Anesthesiology and Critical Care Medicine, University Hospital of Münster, Münster, Germany.2Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh PA.
• Crit. Care Med. 2016 Mar 1; 44 (3): 607-16.

ObjectiveAcute kidney injury is a common complication in critically ill patients and is associated with increased morbidity and mortality. Sepsis, major surgery, and nephrotoxic drugs are the most common causes of acute kidney injury. There is currently no effective strategy available to prevent or treat acute kidney injury. Therefore, novel treatment regimens are required to decrease acute kidney injury prevalence and to improve clinical outcomes. Remote ischemic preconditioning, triggered by brief episodes of ischemia and reperfusion applied in distant tissues or organs before the injury of the target organ, attempts to invoke adaptive responses that protect against acute kidney injury. We sought to evaluate the clinical evidence for remote ischemic preconditioning as a potential strategy to protect the kidney and to review the underlying mechanisms in light of recent studies.Data SourcesWe searched PubMed for studies reporting the effect of remote ischemic preconditioning on kidney function in surgical patients (search terms: "remote ischemic preconditioning," "kidney function," and "surgery"). We also reviewed bibliographies of relevant articles to identify additional citations.Study SelectionPublished studies, consisting of randomized controlled trials, are reviewed.Data ExtractionThe authors used consensus to summarize the evidence behind the use of remote ischemic preconditioning.Data SynthesisIn addition, the authors suggest patient populations and clinical scenarios in which remote ischemic preconditioning might be best applied.ConclusionsSeveral experimental and clinical studies have shown tissue-protective effects of remote ischemic preconditioning in various target organs, including the kidneys. Remote ischemic preconditioning may offer a novel, noninvasive, and inexpensive treatment strategy for decreasing acute kidney injury prevalence in high-risk patients. Although many new studies have further advanced our knowledge in this area, the appropriate intensity of remote ischemic preconditioning, its mechanisms of action, and the role of biomarkers for patient selection and monitoring are still unknown.

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