Ischemic Preconditioning for Prevention of Contrast Nephropathy in The Emergency Department
Ischemic Preconditioning for Prevention of Contrast Nephropathy in The Emergency Department
The purpose of this study is to demonstrate the effectiveness of ischemic preconditioning in
 the emergency department to prevent contrast induced nephropathy
The research will be conducted of emergency medicine department in The Derince Training and
 Research Hospital. Patients ages 18 and older, who will be received contrast enhanced CT scan
 in the emergency medicine department will be included to the study. Patients will be excluded
 from the study if The Mehran Risk Score is under 6 points. The Mehran Risk Score is a scoring
 system for prediction of contrast-induced nephropathy. This CIN (Contrast induced
 nephropathy) risk stratification score based on 8 variables. The variables included in the
 CIN risk score are: 1) patient-related characteristics (i.e., age >75 years, diabetes
 mellitus, chronic congestive heart failure, or admission with acute pulmonary edema,
 hypotension, anemia, and chronic kidney disease); and 2) procedure related characteristics
 (i.e., the use of elective IABP (Intra aortic balloon pump) or increasing volumes of contrast
 media). It is categorized into 4 groups according to MRS (Mehran Risk Score) (low-risk: 5
 (7.5%); medium-risk: 6-10 (14%); high-risk: 11-16 (26.1%); and very high-risk: 16
 (57.3%).Normal salin at a rate of 3 mL/kg/hour per 1 hour before contrast agents exposure
 followed by 1 mL/kg/hour for 6 hours after the procedure is administered whose Mehran risk
 score is greater than 6 in our daily practice. Patients with risk factors for CIN are
 recommended about the necessity of follow-up care with their physicians within 48-72 hours.
 Patients with low risk of contrast induced nephropathy, previous allergic reactions to
 contrast material, hemodynamically unstable and require excessive fluid resuscitation,
 undergoing surgical procedures, require renal-replacement therapy, who refuse to participate
 the study will be excluded. All of the emergency medicine physicians will be informed of the
 study. Participants were randomly assigned into two groups with a 1:1 allocation following
 simple randomization procedures by a program (www.randomization.com) generating an online
 random number. All participating patients will receive the standard hydration schedule as
 mentioned before. Patients in the study group will receive ischemia and reperfusion of the
 arm by inflating a blood pressure cuff around the arm at 50 mmHg above the systolic blood
 pressure for 5 minutes, followed by 5 minutes of reperfusion and this cycle will be repeated
 three times. Patients in sham group, will receive ischemia and reperfusion of the arm by
 inflating a blood pressure cuff around the arm at 10 mmHg below the diastolic blood pressure
 for 5 minutes, followed by 5 minutes of reperfusion and this cycle will be repeated three
 times. The allocation sequence will be concealed from the researchers and participants in
 sealed, sequentially numbered envelopes. Envelopes will be opened by the nurse who will
 administer the protocol. Less than 100 mL of nonionic, hypoosmolar contrast agent will be
 injected in all CT scans.All of the participants will be recommended about the necessity of
 follow-up care with their physicians within 48-72 hours. Participants will be called 72 hours
 after the treatment. Patients who are diagnosed with CIN will be followed for one month to
 see whether they will develop renal failure requiring renal replacement therapy. After 72
 hours the laboratory results will be recorded by the researchers.
Inclusion Criteria:

 -  Participants, older than 18 years old and received contrast enhanced CT scan in the
 emergency medicine department

 -  The Mehran Risk Score is greater than 5 points

 Exclusion Criteria:

 -  The Mehran Risk Score is under 6 points

 -  Participants who doesn't want to enroll the study