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Influence of continuous infusion of low-dose human atrial natriuretic peptide on renal function during cardiac
Akira Sezai1, Mitsumasa Hata, Tetsuya Niino
1Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. asezai@med.nihon-u.ac.jp
Insights
Low-dose human atrial natriuretic peptide (hANP) infusion during coronary artery bypass grafting (CABG) effectively preserved renal function. This treatment reduced post-operative complications and acute kidney injury in cardiac surgery patients.
Area of Science:
- Cardiology
- Nephrology
- Surgical Innovation
Background:
- Acute kidney injury (AKI) following cardiac surgery, particularly coronary artery bypass grafting (CABG), is a significant clinical challenge associated with increased morbidity and mortality.
- Early identification and prevention of AKI are crucial for improving patient outcomes after major cardiovascular procedures.
Purpose of the Study:
- To evaluate the impact of continuous infusion of human atrial natriuretic peptide (hANP) on renal function in patients undergoing CABG.
- To determine if hANP administration can mitigate the incidence of post-operative acute renal failure in this high-risk surgical population.
Main Methods:
- A prospective study involving 504 patients undergoing CABG, randomized into two groups: one receiving a continuous infusion of hANP (0.02 microg/kg/min) from the initiation of cardiopulmonary bypass, and a control group receiving a placebo.
- Comprehensive monitoring of renal function parameters, including serum creatinine, urinary creatinine, and creatinine clearance, was performed pre- and post-operatively.
Main Results:
- The hANP group demonstrated significantly lower post-operative serum creatinine levels and higher creatinine clearance from day 1 to week 1 compared to the placebo group (p < 0.0001).
- Fewer patients in the hANP group experienced elevated creatinine levels (>2.0 mg/dl) (p = 0.0374), and post-operative complications were less frequent (p = 0.0208).
- Although not statistically significant, no patients in the hANP group required hemodialysis, compared to four in the placebo group.
Conclusions:
- Continuous low-dose hANP infusion initiated during cardiopulmonary bypass is an effective strategy for maintaining post-operative renal function in CABG patients.
- Administration of hANP can prevent early post-operative acute renal failure, thereby contributing to enhanced safety in cardiac surgical procedures.
Objectives:
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. (
Clinical Trial Registration Number:
UMIN000001440).
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