The efficacy of human atrial natriuretic peptide in patients with renal dysfunction undergoing cardiac surgery.
OBJECTIVE
The purpose of this study was to investigate the efficacy of carperitide (human atrial natriuretic peptide [h-ANP]) in perioperative management in patients with renal dysfunction, especially its kidney-protecting effects.


METHODS
The subjects were 18 patients who underwent elective cardiac surgery using cardiopulmonary bypass (CPB) with a preoperative serum creatinine (Cr) level of 1.2 mg/dl or more. The subjects were prospectively assigned to 2 groups: an h-ANP-treated group (Group H, n = 10) and a non-h-ANP-treated group (Group N, n = 8). At the beginning of surgery, h-ANP administration was initiated and continued for 5 days or more. The central dose was 0.02 microg/kg/min. The primary end point included the serum Cr level and creatinine clearance (Ccr).


RESULTS
In Group H, Cr level significantly decreased after surgery compared to the preoperative level. The Ccr values were significantly higher 2 and 3 days after surgery than the preoperative values. And the intraoperative urine volume significantly increased. In Group H, an increase in urinary N-acetyl-beta-D-glucosaminidase (NAG) level the day after surgery was significantly inhibited in comparison with Group N.


CONCLUSIONS
The results of this study suggest that in patients with renal dysfunction before cardiac surgery, continuous low-dose h-ANP therapy maintains renal function, preventing its deterioration.
Izumi
Kenta
K
Division of Cardiovascular Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
Eishi
Kiyoyuki
K
Yamachika
Shiro
S
Hashizume
Kouji
K
Tada
Seiichi
S
Yamane
Kentaro
K
Takai
Hideaki
H
Tanigawa
Kazuyoshi
K
Miura
Takashi
T
Nakaji
Shun
S
D000118:Acetylglucosaminidase / Q000652:urine; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism; D001806:Blood Urea Nitrogen; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000097:blood; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D006331:Heart Diseases / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007263:Infusions, Parenteral; D015850:Interleukin-6 / Q000097:blood; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D019990:Perioperative Care; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014563:Urodynamics
D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; C508600:IL6 protein, human; D015850:Interleukin-6; C472955:NPPA protein, human; D014409:Tumor Necrosis Factor-alpha; D009320:Atrial Natriuretic Factor; D003404:Creatinine; D000118:Acetylglucosaminidase