title: Results of low-dose human atrial natriuretic peptide infusion in nondialysis patients with chronic kidney disease undergoing coronary artery bypass grafting: the NU-HIT (Nihon University working group study of low-dose HANP Infusion Therapy during cardiac surgery) trial for CKD.
abstract: OBJECTIVE
  The purpose of this comparative study is to prove the efficacy of the human atrial natriuretic peptide (hANP) in patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery (CABG).
  
  
  BACKGROUND
  CKD is an important risk factor for cardiac surgery.
  
  
  METHODS
  This was a randomized controlled study of 303 patients with CKD who underwent CABG, and were divided into a group who received carperitide infusion and another group without carperitide. The primary endpoints were: 1) the post-operative dialysis-free rate; and 2) serum creatinine (sCr) and estimated glomerular filtration rate. The secondary endpoints were: 1) the early post-operative outcome; 2) outcome at 1 year post-operatively; 3) the maximum sCr, the rate of increase of sCr, and an increase of sCr by ≥ 0.3 mg/dl compared with the pre-operative value; and 4) ANP and cyclic-guanosine monophosphate levels.
  
  
  RESULTS
  The post-operative sCr was significantly lower in the hANP group not only in the post-operative acute stage but also in the first year. The maximum Cr and Cr increase rate were significantly lower in the hANP group (p = 0.00665, p < 0.0001). There was no difference in mortality rate in the first year post-operatively, and fewer cardiac events and patients going on dialysis were found in the hANP group (p < 0.0001 and p = 0.0014, respectively).
  
  
  CONCLUSIONS
  In the post-operative acute stage, carperitide showed cardiorenal protective effects that prevented post-operative cardiac events and initiation of dialysis. Thus, perioperative infusion of low-dose carperitide may have a significant role in management of patients with renal dysfunction undergoing on-pump CABG. (Effectiveness of hANP for Cardiac Surgery in Patients With Moderate to Severe Preoperative Renal Dysfunction Without Dialysis [NU-HIT for CRF]; UMIN000001462).
authors.affiliation: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. asezai.med@gmail.com
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Niino
authors.forename: Isamu
authors.initials: I
authors.lastname: Yoshitake
authors.forename: Satoshi
authors.initials: S
authors.lastname: Unosawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Wakui
authors.forename: Haruka
authors.initials: H
authors.lastname: Kimura
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
authors.forename: Tadateru
authors.initials: T
authors.lastname: Takayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: C472955:NPPA protein, human; D009320:Atrial Natriuretic Factor