title: Reduction in the incidence of acute kidney injury after aortic arch surgery with low-dose atrial natriuretic peptide: a randomised controlled trial.
abstract: BACKGROUND
  Acute kidney injury (AKI) after surgery is associated with an increased risk of adverse events and death. Atrial natriuretic peptide (ANP) dilates the preglomerular renal arteries and inhibits the renin-angiotensin axis. A low-dose ANP infusion increases glomerular filtration rate after cardiovascular surgery, but it is not known whether it reduces the incidence of AKI or the mortality rate.
  
  
  OBJECTIVE
  To evaluate whether an intravenous ANP infusion prevents AKI in patients undergoing aortic arch surgery requiring hypothermic circulatory arrest.
  
  
  METHODS
  A randomised controlled study.
  
  
  METHODS
  Operating room and intensive care unit at Kawasaki Saiwai Hospital, Kanagawa, Japan.
  
  
  METHODS
  Forty-two patients with normal preoperative renal function undergoing elective repair of an aortic arch aneurysm.
  
  
  METHODS
  Patients were assigned randomly to receive a fixed dose of ANP (0.0125 μg (-1) kg(-1)  min) or placebo. The infusion was started after induction of anaesthesia and continued for 24  h postoperatively.
  
  
  METHODS
  The primary end-point was the incidence of AKI within 48 h after surgery.
  
  
  RESULTS
  AKI developed in 30% of patients who received ANP compared with 73% of patients who received placebo (P = 0.014). Intraoperative urine output was almost 1 l greater in patients who received ANP (1865 ± 1299 versus 991 ± 480  ml in the control group, P = 0.005). However, there were no differences in mean arterial pressure or number of episodes of hypotension between the groups. Length of hospital and intensive care stays were not significantly different, nor was there a difference in 30-day mortality. No patients required haemodialysis or continuous renal replacement therapy.
  
  
  CONCLUSIONS
  We found that an intravenous infusion of ANP at 0.0125  μg  kg(-1)  min(-1) is an effective intervention for reducing the incidence of postoperative AKI, and appears to afford a degree of renal protection during and after cardiovascular surgery.
  
  
  BACKGROUND
  Kawasaki ANP trial, UMIN Clinical Trials Registry ID: UMIN000011650.
authors.affiliation: From the Department of Anesthesia, Kawasaki Saiwai Hospital, Saiwai, Kawasaki, Kanagawa (YM, TK), Department of Anesthesiology, School of Medicine, Toho University, Oota-ku, Tokyo (RO), Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Mori
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kamada
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Ochiai
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D062186:Arterial Pressure; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D004311:Double-Blind Method; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D009320:Atrial Natriuretic Factor