title: Renal protective effects and the prevention of contrast-induced nephropathy by atrial natriuretic peptide.
abstract: OBJECTIVE
  This study was designed to examine the protective effects of atrial natriuretic peptide (ANP) on contrast-induced nephropathy (CIN) after coronary angiography.
  
  
  BACKGROUND
  Contrast-induced nephropathy is a common complication after angiography. Some studies have shown that ANP has renal protective effects, but the beneficial effects for CIN prevention remain to be clearly shown.
  
  
  METHODS
  In a prospective, controlled, randomized trial in 254 consecutive patients with serum creatinine concentrations of > or =1.3 mg/dl, patients received either ANP (0.042 microg/kg/min; ANP group, n = 126) or Ringer solution alone (control group, n = 128). Treatment of either type was initiated 4 to 6 h before angiography and continued for 48 h.
  
  
  RESULTS
  There were no significant differences in age, sex, diabetes mellitus, or baseline serum creatinine level between the 2 groups. The prevalence of CIN, defined as a 25% increase in creatinine or an increase in creatinine of > or =0.5 mg/dl from baseline within 48 h, was significantly lower in the ANP group than in the control group (3.2% vs. 11.7%, respectively; p = 0.015). Multivariate analysis revealed that the use of >155 ml of contrast medium (odds ratio: 6.89; p < 0.001) and ANP treatment (odds ratio: 0.24; p = 0.016) were significant predictors of developing CIN. The incidence of an increase in creatinine of > or =25% or of > or =0.5 mg/dl from baseline at 1 month was also significantly lower in the ANP group than in the control group (p = 0.006).
  
  
  CONCLUSIONS
  In addition to hydration, ANP administration is effective in the prevention of CIN in patients with chronic renal failure, and the effect was maintained for 1 month.
authors.affiliation: Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Morikawa
authors.forename: Takahito
authors.initials: T
authors.lastname: Sone
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tsuboi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mukawa
authors.forename: Itsuro
authors.initials: I
authors.lastname: Morishima
authors.forename: Michitaka
authors.initials: M
authors.lastname: Uesugi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Morita
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Numaguchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Okumura
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects / Q000031:analogs & derivatives*; D007677:Kidney Function Tests; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000517:prevention & control*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D009320:Atrial Natriuretic Factor; D003404:Creatinine; D007479:Iopamidol