Figure 1.

Remote Ischemic Preconditioning (RIPC): RIPC represents an experimental approach to provide organ protection. Mechanistically, short cycles of non-detrimental ischemia and reperfusion are applied to the arm or the leg. This approach is thought to drive the stabilization of transcription factors such as hypoxia inducible factors (HIF; e.g. HIF1A or HIF2A).¹¹ This transcriptional program mediates the release of soluble mediators from the ischemic musculature into the systemic circulation. Such mediators could potentially include cytokines (e.g. IL-10), adenosine, circulating nucleotidases, microRNAs or micro-vesicles. Signalling effects of these soluble mediators on remote organs as e.g. the heart or the kidneys could than provide remote organ protection. In the current edition of Anesthesiology, Zarbock and colleagues show that RIPC provides long-term kidney protection by reducing persistent renal dysfunction and renal replacement therapy dependence in cardiac-surgery patients at high risk for acute kidney injury.⁴ RIPC: Remote Ischemic Preconditioning; HIF: Hypoxia-Inducible Factor; IL-10: Interleukin-10; MicroRNA: micro ribonucleic acid.