Key result
Remote ischemic preconditioning across 17 RCTs (N=3,648) consistently reduced acute kidney injury, whereas cardioprotective and neuroprotective effects were heterogeneous and context-dependent.
Why the study?
Despite substantial experimental data on remote ischemic preconditioning (RIPC) for multi-organ protection, clinical results across surgical contexts remain heterogeneous, necessitating a systematic analysis of accumulated evidence, particularly in high-risk and geriatric populations.
Does remote ischemic preconditioning (RIPC) prevent cardio-cerebral and renal complications (troponin elevation, postoperative delirium, postoperative cognitive dysfunction, acute kidney injury, and length of hospitalization) in adult patients undergoing surgical or interventional procedures?
Systematic Review (n=3,648)
Does remote ischemic preconditioning (RIPC) prevent cardio-cerebral and renal complications (troponin elevation, postoperative delirium, postoperative cognitive dysfunction, acute kidney injury, and length of hospitalization) in adult patients undergoing surgical or interventional procedures?
This systematic review of 17 trials shows that while remote ischemic preconditioning consistently reduces postoperative acute kidney injury, its cardioprotective and neuroprotective benefits remain inconsistent and depend heavily on ischemic stimulus intensity and avoidance of propofol anesthesia.
Answers are grounded in this paper and cite their sources.
RIPC warrants consideration for postoperative AKI prevention; confirms consistent nephroprotection while leaving cardioprotective and neuroprotective effects context-dependent.
INTRODUCTION: Remote ischemic preconditioning (RIPC) is a noninvasive multi-organ protection strategy based on the use of short-term ischemia-reperfusion cycles in a peripheral limb, inducing systemic protective effects. Despite a significant body of experimental data, the clinical results of RIPC remain heterogeneous, necessitating a systematic analysis of the accumulated evidence, particularly in high-risk populations. OBJECTIVE: To evaluate the current evidence on the impact of RIPC on cardio-cerebral and renal outcomes across various surgical contexts and to analyze the methodological features of the included studies, including those involving geriatric populations. MATERIALS AND METHODS: The systematic review was conducted in accordance with the PRISMA 2020 guidelines. A literature search was conducted in PubMed, Google Scholar, CENTRAL and eLibrary (for Russian authors) for the period 2020–2026, including original studies. Clinical outcomes assessed included troponin, delirium, cognitive dysfunction, acute kidney injury, and length of hospitalization. Risk of bias was assessed using the Cochrane Risk of Bias tool. RESULTS: The systematic review included 17 studies that met the selection criteria. Most of the included studies were characterized as having a low or moderate risk of bias, with only one pilot randomized controlled trial (RCT) categorized as high risk. Convincing data have been obtained regarding the nephroprotective effect of the method, while the cardioprotective effect demonstrates inconsistent results, and the neuroprotective potential, despite encouraging trends, remains unclear and requires further study. The effectiveness of RIPC significantly depends on the clinical context, the presence of comorbidities, anesthetic management, and the choice of endpoints. CONCLUSIONS: The review demonstrated that RIPC is a promising and safe method of multi-organ protection, with potential for clinical benefit in carefully selected patients. These findings highlight the need for further research focusing on composite cardiovascular outcomes, particularly in the geriatric population.
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Shayakhanov et al. (2026) conducted a systematic review in Elective or emergency surgical and interventional procedures (cardiac surgery, PCI/coronary angiography, non-cardiac surgery, traumatic brain injury) (n=3,648). Remote ischemic preconditioning (RIPC) vs. Standard perioperative care without RIPC was evaluated on Cardiocerebral and renal outcomes (troponin, postoperative delirium, postoperative cognitive dysfunction, acute kidney injury, and length of hospitalization). Remote ischemic preconditioning across 17 RCTs (N=3,648) consistently reduced acute kidney injury, whereas cardioprotective and neuroprotective effects were heterogeneous and context-dependent.
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