by wasoxygen

Medical blogger Dr. Aaron Carroll summarizes a recent research paper:

The gist of it is that with cardiac surgery, there’s a significant risk of developing acute kidney injury. Up to 30% of patients wind up with it, and there’s not much we can do about it. But there’s a growing belief that “remote ischemic preconditioning” might help. What they do is fool the body into being concerned that ischemia, or periods of no oxygen, are coming. The theory is that this gets the tricked tissues to release certain factors that warn the rest of the body (ie kidneys) to slow down and prepare for badness. Then, when the cardiac surgery comes, the kidneys are better prepared for a hit.

Basically, doctors place a blood pressure cuff on the upper arm. Then they inflate it to at least 200 mm Hg (which is high) for five minutes. Then they deflate it for five minutes. They do this three times in a row. Then they go ahead and operate normally.

The treatment was effective:

More than half (52.5%) of the patients who received the placebo developed an acute kidney injury. Much fewer (37.5%) of those that received remote ischemic preconditioning developed one. That’s an absolute risk reduction of 15%... Awesome, right? This costs pretty much NOTHING, and it reduced bad outcomes in a high risk population hugely.

But the doctor predicts that the lack of profit potential and sex appeal means this technique will probably not become widespread. As a critic of public funding, I am sympathetic to the doctor's complaint that NIH won't pursue this treatment because more research would require confirming old results, and NIH looks for "innovation" in its grant guidelines.

But the doctor is skeptical of private forces backing the procedure as well:

This is too “simple”. It’s tightening a blood pressure cuff. That won’t interest any rich donors to fund it. It won’t interest foundations. And industry won’t fund it—there’s no money in it.

Is the doctor right, that no one cares enough about kidney health to follow up on this? I wouldn't give up on the profit motive. I see hospital advertisements all the time, and being able to claim significantly fewer kidney complications for patients would seem like something to brag about. Even if a hospital does not self-promote, surveys like those by U.S. News should reflect improved patient outcomes.