Influence of continuous infusion of low-dose human atrial natriuretic peptide on renal function during cardiac surgery: a randomized controlled study.
OBJECTIVE
The purpose of this study was to determine the effect of human atrial natriuretic peptide (hANP) in patients who underwent coronary artery bypass grafting (CABG) on renal function.


BACKGROUND
Acute renal failure after cardiac surgery is associated with high morbidity and mortality.


METHODS
A total of 504 patients who underwent CABG were divided into 2 groups: 1 group received hANP at 0.02 microg/kg/min from the start of cardiopulmonary bypass (hANP group), and 1 group did not receive hANP (placebo group). Various parameters were measured before and after surgery.


RESULTS
There was no difference in mortality between the 2 groups, but post-operative complications were less frequent in the hANP group (p = 0.0208). In the hANP group, serum creatinine (Cr) was significantly lower and urinary Cr and Cr clearance were significantly higher from post-operative day 1 to week 1. The maximum post-operative Cr level and percent increase of Cr were significantly lower in the hANP group (p < 0.0001). Patients with Cr exceeding 2.0 mg/dl included 1 in the hANP group and 8 in the placebo group, showing a significant difference (p = 0.0374). Four patients in the placebo group and none in the hANP group required hemodialysis, but the difference was not statistically significant.


CONCLUSIONS
Continuous infusion of low-dose hANP from the start of cardiopulmonary bypass effectively maintained post-operative renal function. Infusion of hANP prevents early post-operative acute renal failure and helps to achieve safer cardiac surgery. (


BACKGROUND
UMIN000001440).
Sezai
Akira
A
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. asezai@med.nihon-u.ac.jp
Hata
Mitsumasa
M
Niino
Tetsuya
T
Yoshitake
Isamu
I
Unosawa
Satoshi
S
Wakui
Shinji
S
Osaka
Shunji
S
Takayama
Tadateru
T
Kasamaki
Yuji
Y
Hirayama
Atsushi
A
Minami
Kazutomo
K
D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage* / Q000493:pharmacokinetics; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood / Q000652:urine; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods*; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D051437:Renal Insufficiency / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome
D009320:Atrial Natriuretic Factor; D003404:Creatinine