title: Effect of enhanced external counterpulsation treatment on renal function in cardiac patients.
abstract: BACKGROUND
  Enhanced external counterpulsation (EECP) enhances coronary perfusion and reduces left ventricular afterload. However, the role of EECP on renal function in cardiac patients is unknown. Our aim was to assess renal function determined by serum cystatin C in cardiac patients before and after EECP treatment.
  
  
  METHODS
  A prospective observational longitudinal study was conducted in order to evaluate renal function using serum cystatin C (Cys C) and estimated glomerular filtration rate (GFR) after 35 sessions of EECP treatment in 30 patients with chronic stable angina and/or heart failure. The median (IQR) time for follow-up period after starting EECP treatment was 16 (10-24) months.
  
  
  RESULTS
  Cys C significantly declined from 1.00 (0.78-1.31) to 0.94 (0.77-1.27) mg/L (p < 0.001) and estimated GFR increased from 70.47 (43.88-89.41) to 76.27 (49.02-91.46) mL/min/1.73 m(2) (p = 0.006) after EECP treatment. Subgroup analysis showed that patients with baseline GFR <60 mL/min/1.73 m(2) or NT-proBNP >125 pg/mL had a significant decrease in Cys C when compared to other groups (p < 0.01).
  
  
  CONCLUSIONS
  The study demonstrated that EECP could improve long-term renal function in cardiac patients especially in cases with declined renal function or with high NT-proBNP.
  
  
  BACKGROUND
  The study was registered in the clinical trial as International Standard Randomized Controlled Trial Number ISRCTN11560035.
authors.affiliation: Division of Nephrology, Department of Medicine, Phramongkutklao Hospital, 315 Rajavithi Road, Rajathevi, Bangkok 10400, Thailand. prajej@gmail.com.
authors.forename: Prajej
authors.initials: P
authors.lastname: Ruangkanchanasetr
authors.forename: Nithi
authors.initials: N
authors.lastname: Mahanonda
authors.forename: Ongkarn
authors.initials: O
authors.lastname: Raungratanaamporn
authors.forename: Piyanuj
authors.initials: P
authors.lastname: Ruckpanich
authors.forename: Chagriya
authors.initials: C
authors.lastname: Kitiyakara
authors.forename: Amnart
authors.initials: A
authors.lastname: Chaiprasert
authors.forename: Surawat
authors.initials: S
authors.lastname: Adirekkiat
authors.forename: Dollapas
authors.initials: D
authors.lastname: Punpanich
authors.forename: Somlak
authors.initials: S
authors.lastname: Vanavanan
authors.forename: Anchalee
authors.initials: A
authors.lastname: Chittamma
authors.forename: Thanom
authors.initials: T
authors.lastname: Supaporn
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D059347:Cardio-Renal Syndrome / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D015908:Counterpulsation / Q000379:methods*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D055316:Cystatin C
references.citation: Clin Chem Lab Med. 2008;46(12):1664-86
references.pmid: 18973461
references.citation: J Cardiovasc Pharmacol Ther. 2006 Dec;11(4):271-3
references.pmid: 17220474
references.citation: Eur Heart J. 2001 Aug;22(16):1451-8
references.pmid: 11482918
references.citation: Circulation. 2006 Feb 7;113(5):671-8
references.pmid: 16461840
references.citation: Am J Cardiol. 1999 Oct 15;84(8):950-2, A7-8
references.pmid: 10532522
references.citation: Int Urol Nephrol. 2012 Oct;44(5):1589-90; author reply 1591-2
references.pmid: 21877120
references.citation: J Cardiovasc Med (Hagerstown). 2008 Jul;9(7):694-9
references.pmid: 18545069
references.citation: J Am Coll Cardiol. 2010 Feb 2;55(5):441-50
references.pmid: 20117457
references.citation: Am J Kidney Dis. 2006 Nov;48(5):712-9
references.pmid: 17059990
references.citation: Nat Clin Pract Cardiovasc Med. 2006 Nov;3(11):623-32
references.pmid: 17063167
references.citation: Int Urol Nephrol. 2012 Oct;44(5):1461-6
references.pmid: 21424573
references.citation: J Am Soc Nephrol. 2005 May;16(5):1404-12
references.pmid: 15788478
references.citation: Eur J Heart Fail. 2008 Apr;10(4):404-11
references.pmid: 18358775
references.citation: Am J Kidney Dis. 2002 Aug;40(2):221-6
references.pmid: 12148093
references.citation: Clin J Am Soc Nephrol. 2008 Mar;3(2):348-54
references.pmid: 18235143
references.citation: Curr Treat Options Cardiovasc Med. 2009 Feb;11(1):54-60
references.pmid: 19141261
references.citation: Am J Cardiol. 2008 Feb 4;101(3A):25-8
references.pmid: 18243854
references.citation: Am Heart J. 2006 Jan;151(1):139
references.pmid: 16368306
references.citation: J Am Coll Cardiol. 1999 Jun;33(7):1833-40
references.pmid: 10362181
references.citation: Clin Chim Acta. 2003 Dec;338(1-2):87-90
references.pmid: 14637271
references.citation: J Am Coll Cardiol. 2008 Nov 4;52(19):1527-39
references.pmid: 19007588
references.citation: Cardiology. 2008;110(3):160-6
references.pmid: 18057883
references.citation: Clin Cardiol. 2008 Apr;31(4):159-64
references.pmid: 18404725
references.citation: Eur J Clin Invest. 2009 Oct;39(10):866-75
references.pmid: 19572918
references.citation: N Engl J Med. 2012 Jul 5;367(1):20-9
references.pmid: 22762315
references.citation: J Am Coll Cardiol. 1999 Jun;33(7):1841-2
references.pmid: 10362182
references.citation: Am J Kidney Dis. 2008 Mar;51(3):395-406
references.pmid: 18295055
references.citation: J Am Coll Cardiol. 2006 Sep 19;48(6):1198-205
references.pmid: 16979005
references.citation: Eur J Heart Fail. 2005 Jun;7(4):537-41
references.pmid: 15921792
references.citation: Curr Heart Fail Rep. 2006 Apr;3(1):25-32
references.pmid: 16684494
references.citation: Nephrol Dial Transplant. 2005 May;20(5):920-6
references.pmid: 15788437
references.citation: Clin Exp Nephrol. 2008 Apr;12(2):132-139
references.pmid: 18317874
references.citation: CMAJ. 2004 Apr 13;170(8):1223-4
references.pmid: 15078841
references.citation: Circ Heart Fail. 2009 Mar;2(2):98-104
references.pmid: 19808324
references.citation: J Am Coll Cardiol. 2007 Oct 16;50(16):1523-31
references.pmid: 17936150
references.citation: Am J Physiol Heart Circ Physiol. 2006 Jan;290(1):H248-54
references.pmid: 16113071
references.citation: Eur Heart J. 2001 Aug;22(16):1363-4
references.pmid: 11482912
references.citation: J Am Coll Cardiol. 2003 Jun 4;41(11):1918-25
references.pmid: 12798558
references.citation: Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
references.pmid: 11904577
references.citation: N Engl J Med. 2004 Sep 23;351(13):1285-95
references.pmid: 15385655