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Preventive effect and mechanism of compound Danshen dripping pills on contrast-induced nephropathy after percutaneous
Han Fu1,2, Linrui Wang3, Shuo Ying4
1Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Compound Danshen dripping pills (CDDP) significantly reduced contrast-induced nephropathy (CIN) incidence in patients undergoing coronary stent implantation. This study highlights CDDP
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) is a frequent complication following coronary stent implantation.
- Compound Danshen dripping pills (CDDP) are used for cardiovascular conditions and may mitigate CIN.
- Previous evidence on CDDP's effectiveness in preventing CIN after stenting is inconclusive.
Purpose of the Study:
- To prospectively evaluate the efficacy of Compound Danshen dripping pills (CDDP) in preventing contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI).
- To assess the impact of CDDP on renal function markers, inflammation, and oxidative stress post-PCI.
- To identify patient subgroups at higher risk for CIN.
Main Methods:
- A prospective, randomized, single-center, single-blind, controlled trial involving 822 patients with unstable angina or NSTEMI undergoing PCI.
- Patients received either CDDP plus hydration therapy (n=411) or hydration therapy alone (n=411) for 30 days.
- Primary endpoint was CIN incidence, defined by serum creatinine elevation within 48-72 hours post-contrast exposure.
Main Results:
- The CDDP group exhibited significantly lower serum creatinine and blood urea nitrogen levels at 48 and 72 hours post-operation compared to the hydration-only group.
- CIN incidence was significantly reduced in patients pre-treated with CDDP.
- Elevated CIN risk was associated with left ventricular ejection fraction <50%, contrast volume ≥160ml, and hypertension. Significant differences in NGAL, TNF-α, SOD, and MDA levels were observed between groups, but not in Bax, Bcl-2, or Casepase-9.
Conclusions:
- Pre-treatment with Compound Danshen dripping pills (CDDP) is effective in preventing contrast-induced nephropathy (CIN) after coronary stent implantation.
- The protective mechanism of CDDP may involve the modulation of inflammatory responses and oxidative stress.
- Risk stratification for CIN should consider factors like LVEF, contrast volume, and hypertension.
Background:
Contrast-induced nephropathy (CIN) is one of the most common complications after coronary stent implantation due to the extensive development of coronary catheterization technology. Compound Danshen dripping pills (CDDP) are clinically used as cardiovascular drugs, relieving systemic inflammatory response. Previous studies have observed that CDDP can decrease CIN incidence after coronary stent implantation with uncertain effectiveness.
Methods:
We conducted a prospective, randomized, single-center, single-blind, controlled trial. We enrolled patients 18 years and older with unstable angina pectoris and NSTEMI who underwent PCI at the Tianjin Chest Hospital between November 1, 2021, and November 31, 2022, and followed for 30 days. Patients were randomized to CDDP and hydration therapy (10 capsules three times/day; N = 411) or hydration only (N = 411). The primary outcome was the contrast nephropathy incidence, defined as an elevation in serum creatinine by more than 25% or 44 μmol/L from baseline within 48-72 h of contrast exposure. Secondary outcomes included major adverse cardiovascular events post-surgery and during follow-up.
Results:
After 48 h of operation, the two groups had statistical significance in Scr and BUN values (80.0 ± 12.59 vs. 84.43 ± 13.49, P < 0.05; 6.22 ± 1.01 vs. 6.40 ± 0.93, P < 0.05). The difference in Scr in 72 h between the two groups was statistically significant (76.42 ± 10.92 vs. 79.06 ± 11.58, P < 0.05). The CIN incidence was significantly lower in the CDDP group than in the hydration group. The CIN risk was significantly elevated in patients with LVEF <50%, contrast volume ≥160 ml, and hypertension, after 48 and 72 h of operation. The serum inflammation index levels NGAL, TNF-α, oxidative stress indexes SOD, and MDA significantly differed between the two groups. However, there was no significant difference in serum apoptosis indexes Bax, Bcl-2, and Casepase-9.
Conclusions:
CDDP pre-treatment could prevent contrast-induced nephropathy. Inflammatory response and oxidative stress could be significant in the CDDP mechanism.
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