Evaluation of the Efficacy of Remote Ischemic Preconditioning in Reducing Renal Injury in Patients Undergoing Partial Nephrectomy: A Systematic Review.

Partial nephrectomy often results in temporary renal ischemia, predisposing the kidney to ischemia-reperfusion injury. Remote ischemic preconditioning is a novel technique that has emerged as a potential strategy to attenuate renal ischemia-reperfusion injury. Remote ischemic preconditioning involves brief, controlled ischemia of a limb, which induces the development of systemic protective mechanisms against ischemia. This systematic review evaluates the efficacy of remote ischemic preconditioning in reducing renal injury post-partial nephrectomy, focusing on urinary biomarkers, renal function parameters and long-term kidney function outcomes.  This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and comprehensive literature searches were performed across PubMed, EMBASE, Cochrane and SCOPUS for studies published from 1st January 2015 to 15th June 2025. Eligible studies included randomized controlled trials, cohort and case-control studies examining remote ischemic preconditioning in adult patients undergoing partial nephrectomy, with outcomes involving urinary biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and renal function parameters such as estimated glomerular filtration rate (eGFR) and serum creatinine. Risk of bias was assessed using frameworks such as Cochrane's RoB 2.0, ROBINS-I, and Newcastle-Ottawa Scale.  The results were mixed with five studies meeting the inclusion criteria, comprising four randomised controlled trials and one cohort study. High-quality trials demonstrated significant short-term improvements in postoperative eGFR, reduced pain and shorter hospital stays when remote ischemic preconditioning was used as part of a multimodal strategy. Others showed reduced urinary NGAL or attenuated serum creatinine rise, but without consistent functional benefit. Variability in remote ischemic preconditioning protocols, outcome measures, and patient populations limited direct comparisons. Overall, studies were at low to moderate risk of bias.  Remote ischemic preconditioning appears to be a safe and feasible intervention with potential short-term renal benefits following partial nephrectomy. However, evidence remains inconclusive due to heterogeneity and limited long-term data. Future large-scale, standardized trials incorporating sensitive biomarkers and robust renal function outcomes are needed to clarify the clinical utility of performing remote ischemic preconditioning and optimizing its application in renal surgery.