Effects of atrial natriuretic peptide (99-126) in chronic renal disease in man

Plasma concentrations of human atrial natriuretic peptide (99-126) are elevated in patients with end-stage chronic renal failure and on haemodialysis. Plasma atrial natriuretic peptide (ANP) concentrations change with extracellular fluid volume, suggesting that ANP continues to have a role in chronic renal failure. We have studied the effects of an infusion (5 pmol/kg per min) in subjects with chronic renal failure (CCr) less than 30 ml/min per 1.73 m2). Glomerular filtration rate and effective renal plasma flow increased by 23% (P less than 0.01) and 27% (P less than 0.01) respectively and sodium excretion more than doubled. Systolic and diastolic blood pressures decreased by 14 (SD 1.6) and 6 (SD 0.8) mmHg respectively (P less than 0.001), and plasma renin activity declined (P less than 0.01). Plasma ANP concentrations were elevated compared to normal subjects and reached a peak of 224 (SD 87) pmol/l at the end of the infusion. Plasma half-life was 4.8 (SD 2.7) min. Plasma concentrations are elevated in chronic renal failure and ANP may play a physiological role in controlling extracellular fluid volume and blood pressure.