[Urodilatin (INN: ularitide). A new peptide in the treatment of acute kidney failure following liver transplantation].
Acute renal failure (ARF) is a serious complication following liver transplantation. Many therapeutic regimens have been used so far but with limited success. Urodilatin (URO) is a new member of the atrial natriuretic peptide (ANP) family. When administered intravenously, URO induces strong diuresis and natriuresis with tolerable hemodynamic side effects. Preliminary non-controlled clinical studies demonstrate beneficial effects using URO as a therapeutic agent in patients suffering from ARF following heart and liver transplantation (HTx, LTx). These results prompted us to initiate this first controlled clinical trial to investigate whether URO infusion can improve renal function in patients with emerging ARF following LTx.


METHODS
We initiated a randomized, double-blind, placebo-controlled study comparing five patients receiving i.v. URO infusion (20 ng/kg bw/min) with four placebo patients after informed consent was obtained. Optional inclusion criteria were oliguria/anuria ( < 0.5 ml/kg/h), refractory to conventional treatment including administration of furosemide and dopamine, increase of serum creatinine to a least 200% of preoperative values, and BUN levels > or = 25 mmol/l. The primary parameters for efficacy was the frequency of hemodialysis/hemofiltration.


RESULTS
The frequency of hemodialysis/hemofiltration during URO or placebo infusion was significantly reduced (P = 0.03) in the URO-treated patients in comparison with placebo. BUN levels did not differ between two groups, but serum creatinine levels were consistently lower in the URO group. Diuresis tended to be stronger in the URO group, maintaining high levels despite a significant reduction in the administration of furosemide in comparison with placebo.


CONCLUSIONS
We conclude that URO seems to be a new approach for the treatment of therapy-resistant postoperative ARF following LTx.
Kuse
E R
ER
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover.
Meyer
M
M
Constantin
R
R
Oldhafer
K
K
Schlitt
H J
HJ
Schulz-Knappe
P
P
Uberbacher
H J
HJ
Pichlmayr
R
R
Forssmann
W G
WG
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use*; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D006435:Renal Dialysis
D004232:Diuretics; D010446:Peptide Fragments; C056452:Ularitide; D009320:Atrial Natriuretic Factor
Urodilatin (INN: Ularitide). Ein neues Peptid in der Intensivbehandlung des akuten Nierenversagens nach Lebertransplantation.