Effects of human atrial natriuretic peptide on renal function in patients undergoing abdominal aortic aneurysm repair.
OBJECTIVE
Ischemia-reperfusion injury is an important cause of renal dysfunction after abdominal aortic aneurysm repair. Human atrial natriuretic peptide (hANP) is a potent endogenous natriuretic, diuretic, and vasorelaxant peptide. The objective of the present study was to evaluate the effects of hANP on renal function in patients undergoing abdominal aortic aneurysm repair.


METHODS
A prospective, randomized, placebo-controlled study


METHODS
Intensive care unit of a university hospital.


METHODS
Forty patients undergoing elective abdominal aortic aneurysm repair.


METHODS
The patients were randomized to receive a continuous infusion of either hANP (0.01-0.05 microg/kg/min) (n = 20) or placebo (n = 20) immediately before aortic cross-clamping. The infusion of hANP or placebo continued for 48 hrs.


RESULTS
Blood and urine samples were taken before surgery, at admission to the intensive care unit, and on days 1, 2, and 3 postoperatively, for measurement of serum concentrations of sodium, creatinine, and blood urea nitrogen and plasma concentrations of ANP and brain natriuretic peptide (BNP). Urine volume and urinary concentrations of N-acetyl-beta-D-glucosaminidase (NAG), sodium, and creatinine were also measured. The mean plasma concentration of ANP was significantly higher in the hANP group than in the placebo group. The mean plasma BNP concentration was significantly lower in the hANP group than in the placebo group. The mean serum concentrations of creatinine and blood urea nitrogen were significantly (p < .05) lower in the hANP group than in the placebo group. The mean urine volume and mean creatinine clearance were significantly (p < .05) higher in the hANP group than in the placebo group. The mean urinary NAG/creatinine ratio was significantly (p < .05) lower in the hANP group than in the placebo group.


CONCLUSIONS
The intraoperative and postoperative infusion of low-dose hANP preserved renal function in patients undergoing abdominal aortic aneurysm repair. Further studies are needed to assess the efficacy of prophylactic hANP infusion on perioperative renal outcome.
Mitaka
Chieko
C
Department of Critical Care Medicine, Tokyo Medical and Dental University Graduate School, Tokyo, Japan. c.mitaka.icu@tmd.ac.jp
Kudo
Toshifumi
T
Jibiki
Masatoshi
M
Sugano
Norihide
N
Inoue
Yoshinori
Y
Makita
Koshi
K
Imai
Takasuke
T
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D009320:Atrial Natriuretic Factor / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000502:physiology*; D008297:Male; D011446:Prospective Studies
D009320:Atrial Natriuretic Factor