Renal protective effects and the prevention of contrast-induced nephropathy by atrial natriuretic peptide.
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.
Morikawa
Shuji
S
Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Sone
Takahito
T
Tsuboi
Hideyuki
H
Mukawa
Hiroaki
H
Morishima
Itsuro
I
Uesugi
Michitaka
M
Morita
Yasuhiro
Y
Numaguchi
Yasushi
Y
Okumura
Kenji
K
Murohara
Toyoaki
T
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*
D003287:Contrast Media; C057937:iomeprol; D009320:Atrial Natriuretic Factor; D003404:Creatinine; D007479:Iopamidol