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

Abstract

Objective To determine whether remote ischemic preconditioning (RIPC) improves renal outcomes in children undergoing pediatric cardiac surgery. Method A systematic search of PubMed, EMBASE, and the Cochrane Library included randomized controlled trials (RCTs) assessing the effect of RIPC on the incidence of postoperative acute kidney injury (AKI) and ICU length of stay. Results Six RCTs with 1098 patients were included.RIPC significantly reduced the incidence of AKI (OR = 0.38, 95% CI: 0.25–0.60, P < 0.00001, I²=38%). There was no significant effect on postoperative sCr, TNF-α levels and ICU length of stay (all P values > 0.05, I² >80%). Sensitivity analyses showed a large impact of some studies on the results. Conclusion 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.