Reduction in risk of contrast-induced nephropathy in patients with chronic kidney disease and diabetes mellitus by enhanced external counterpulsation

Abstract

ObjectiveTo evaluate the efficacy of enhanced external counterpulsation (EECP) in the prevention of contrast-induced nephropathy (CIN) in patients with combined chronic kidney disease (CKD) and diabetes mellitus (DM) by comparing the changes in renal function-related indicators in patients before and after coronary angiography (CAG) or percutaneous coronary intervention (PCI).MethodsThere were 230 subjects consecutively included in the study. Of these, 30 cases with DM underwent rehydration therapy, and 200 cases underwent EECP therapy in addition to rehydration therapy, comprising 53 patients with DM and 147 patients without. All the patients were tested to measure the renal function indicators before and after CAG/PCI.ResultsThe postoperative results of blood urea nitrogen (BUN), serum creatinine (Scr), estimated glomerular filtration rate (eGFR), B2 microglobulin, and high-sensitivity C-reactive protein in the three groups showed a statistically significant difference (P < 0.05). After EECP therapy, patients with DM showed a significant decrease in BUN (9.1 ± 4.2 vs. 7.2 ± 3.0, t = 3.899, P < 0.001) and a significant increase in eGFR (41.5 ± 12.7 vs. 44.0 ± 15.6, t = −2.031, P = 0.047), while the patients without DM showed a more significant difference (P < 0.001). Patients with DM showed a lower percentage of elevated Scr (66.7% vs. 43.4%, P = 0.042), a higher percentage of elevated eGFR (30.0% vs. 52.8%, P = 0.044), and a lower incidence of CIN (16.7% vs. 3.8%, P = 0.042) after EECP therapy.ConclusionTreatment with EECP can reduce Scr in patients with combined CKD and DM post CAG/PCI, increase eGFR, and decrease the incidence of CIN.

Enhanced external counterpulsation, focusing on its effect on kidney function, and utilization in patients with kidney diseases: a systematic review

“…Zeng et al [ 24 ] explored this protective effect of EECP in patients with chronic kidney disease (CKD) with or without diabetes mellitus receiving intra-arterial contrast in coronary angiography procedure, who had high risk for contrast-induced kidney injury. Unlike the previous study, the authors applied two EECP sessions, one before the procedure and the other after radiocontrast exposure.…”

“…The postoperative estimated GFR was increased in those receiving EECP therapy (44.0 ± 15.6, compared with 41.5 ± 12.7 mL/min/1.73 m 2 , P = 0.047). The incidence of contrast-induced kidney injury was significantly lower with EECP therapy (3.8%, compared with 16.7% in those receiving standard 0.9% NaCl hydration alone, P -value 0.042) along with lower high-sensitivity C-reactive protein, possibly reflecting reduced renal inflammation from contrast media [ 24 ].…”

“…The study may be underpowered due to the low incidence of kidney injury. Another non-randomized study by Zeng et al [ 24 ] lately investigated patients in a more realistic manner by including patients at high risk for contrast-induced kidney injury, such as diabetes mellitus, or CKD, undergoing coronary intervention, and repeating the second EECP session after contrast exposure. The similar renoprotective effect of EECP found in this study strengthened the potential benefit of EECP in preventing contrast-induced kidney injury in various patient subgroups.…”

Impact of Enhanced External Counter-pulsation Therapy on Glycaemic Control in People With Prediabetes and Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

“…21 EECP therapy has also been shown to reduce the risk of contrast-induced nephropathy in patients with T2DM with CAD undergoing coronary angiography or percutaneous coronary intervention. 22 A few small studies have suggested the beneficial impact of EECP therapy on transcranial Doppler middle cerebral artery flow velocities and National Institutes of Health Stroke Scale scores in patients with acute ischaemic stroke. 23,24 The impact of EECP therapy on other macrovascular and microvascular complications of diabetes is not known and remains an important area of future research.…”

Enhanced external counterpulsation modulates the heartbeat evoked potential

“…As the exploration of mechanisms deepens, the effects of EECP including inhibition of oxidative stress, anti-inflammation, vasculogenesis and angiogenesis have been recently revealed ( Shen et al, 2020 ). Subsequently, studies of EECP have broadened in conditions like type 2 diabetes, erectile dysfunction, and psychiatric diseases ( Springer et al, 2001 ; Raeissadat et al, 2018 ; Zeng et al, 2022 ). It is important to learn more about the effects of EECP and to explore potential mechanisms that will lead to optimized therapy and aid prognosis.…”