Data Sheet 1_Remote ischemic preconditioning reduces contrast-induced nephropathy in patients undergoing coronary angiography or percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials.docx

Trial sequential analysis was performed for dichotomous outcomes to estimate the robustness of the cumulative evidence and the required information size. This study was prospectively registered with PROSPERO (CRD420251269657).</p>Results<p>Twenty-six RCTs including 4,169 participants were included. Overall, RIPC significantly reduced the risk of CIN compared with the control treatment (RR 0.49, 95% CI 0.41–0.59, P < 0.00001; I² = 0%).

Regarding renal function, RIPC significantly attenuated postprocedural increases in serum creatinine levels (SMD −1.00, 95% CI −1.60 to −0.39, P = 0.001) and was associated with lower postprocedural serum creatinine levels (SMD −0.23, 95% CI −0.39 to −0.08, P = 0.003). RIPC was also associated with a lower risk of major adverse events (MAEs) (RR 0.55, 95% CI 0.41–0.75, P = 0.0001). No significant differences were observed in postprocedural eGFR, neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, all-cause mortality, dialysis requirement, or rehospitalization.</p>Conclusion<p>In patients undergoing coronary angiography or percutaneous coronary intervention, RIPC was associated with reduced risks of CIN and MAEs, attenuated postprocedural increases in serum creatinine levels, and lower postprocedural serum creatinine levels, while evidence for postprocedural eGFR, NGAL, cystatin C, and clinical outcomes remains inconclusive.</p>Systematic Review Registration<p>crd.york.ac.uk/PROSPERO/view/CRD420251269657, PROSPERO CRD420251269657.</p>