I had mixed feelings after reading the September paper about ischemic preconditioning. On one hand I think it would be so nice if we could prevent kidney injury just by squeezing the patient’s arm before the surgery. In the other, it is clearly to good to be true.
For any intervention to work, it needs to address the dominant cause of renal failure in the context of cardiac surgery. What is the dominant cause? No one knows. Everybody has hypotheses for that. Anyway, I would guess that “lack of ischemic preconditioning” is not the dominant cause. It is also possible that post-cardiac surgery AKI has several different causes still to be found.
This is the result of not having a disease model to articulate pre-clinical and clinical research. Researchers end up trying random interventions just to see what happens.
Very good post, as always!
I had mixed feelings after reading the September paper about ischemic preconditioning. On one hand I think it would be so nice if we could prevent kidney injury just by squeezing the patient’s arm before the surgery. In the other, it is clearly to good to be true.
For any intervention to work, it needs to address the dominant cause of renal failure in the context of cardiac surgery. What is the dominant cause? No one knows. Everybody has hypotheses for that. Anyway, I would guess that “lack of ischemic preconditioning” is not the dominant cause. It is also possible that post-cardiac surgery AKI has several different causes still to be found.
This is the result of not having a disease model to articulate pre-clinical and clinical research. Researchers end up trying random interventions just to see what happens.
This is more or less what I argue here:
https://thethoughtfulintensivist.substack.com/p/dont-clinical-trial-if-you-cant-formulate?r=20qrtz