# Remote ischemic preconditioning for renal and cardiac protection in congestive heart failure (RICH) trial

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Contrast-associated acute kidney injury (CA-AKI) is a common complication of intravenous, iodinated
contrast media, that is widely used for coronary angiography and percutaneous coronary intervention
(PCI) in patients with coronary artery disease (CAD) and heart failure (HF). An estimated 38 million people
worldwide suffer from HF most frequently as a consequence of CAD, the number one killer of all adults in
the US. The expected growth of the elderly population including Veterans is estimated to be paralleled by a
significant increase (50% in the US) in the number of patients diagnosed with HF every year. Although PCI
restores blood flow to the heart and improves myocardial function in patients with HF, the contrast
media used for the procedure can cause CA-AKI, possibly mediated by contrast–induced
vasoconstriction of renal blood vessels and free radical–mediated direct renal tubular toxicity. The
incidence of CA-AKI is estimated to range between 10 and 50% in patients undergoing coronary
angiography and PCI with higher rates in patients with HF with reduced left ventricular ejection fraction
(LVEF). In the U.S, approximately 1.4 million coronary angiogram procedures are performed each year.
Among the U.S Veterans alone, approximately 30,000 coronary angiograms are performed annually, and
over 1 million contrast-enhanced imaging studies are performed for other various purposes. This estimate
is expected to increase exponentially in the next few decades. With increasing use of contrast media, the
prevalence of CA-AKI is also expected to rise. CA-AKI predicts elevated risk of heart attack, longer hospital
stay, more complicated hospitalization course, and higher in-hospital mortality. Although, periprocedural
administration of isotonic saline intravenous fluid (IVF) has been the standard intervention to prevent CA-
AKI, patients with HF with reduced LVEF may not tolerate IVF. Unfortunately, all the major clinical trials
evaluating prophylactic IVF and other agents excluded patients with HF. Currently, there is no alternative
preventive therapy for CA-AKI in patients with congestive HF with reduced LVEF who cannot
tolerate IVF. This study proposes remote ischemic pre-conditioning (RIPC) elicited by application of one or
more, brief episodes of ischemia and reperfusion of a limb, as a promising alternative therapy for
preventing or attenuating CA-AKI. Given that renal ischemic injury and tubular toxicity are the most
common pathophysiological concepts of CA-AKI, it stands to reason that RIPC may prevent CA-AKI via
nitrite-induced vasodilation and damage associated molecular protein -mediated renal cell protection. In the
preliminary analysis of data of patients with heart attack, an association of RIPC with lower rate of CA-AKI
and in-hospital mortality was observed. In the subgroup with HF with reduced LVEF, RIPC was associated
with lower incidence of CA-AKI, HF symptoms and lower level of plasma brain natriuretic peptide (BNP).
Taken together, th...

## Key facts

- **NIH application ID:** 10731357
- **Project number:** 5I01CX002045-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Oladipupo Olafiranye
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-10-01 → 2027-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10731357

## Citation

> US National Institutes of Health, RePORTER application 10731357, Remote ischemic preconditioning for renal and cardiac protection in congestive heart failure (RICH) trial (5I01CX002045-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10731357. Licensed CC0.

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