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Atrial natriuretic peptide for preventing and treating acute kidney injury
Sagar U Nigwekar1, Sankar D Navaneethan, Chirag R Parikh
1Rochester General Hospital, University of Rochester School of Medicine and Dentistry, 1425 Portland Ave, Rochester, NY, USA, 14621.
Insights
Low-dose atrial natriuretic peptide (ANP) may reduce the need for renal replacement therapy (RRT) in patients at risk of or with acute kidney injury (AKI). High-dose ANP was linked to adverse events, warranting further investigation in specific settings.
Area of Science:
- Nephrology
- Critical Care Medicine
- Pharmacology
Background:
- Acute kidney injury (AKI) is a prevalent and serious condition in hospitalized patients with high morbidity and mortality.
- Despite advancements, treatment outcomes for AKI have remained largely unchanged over the past four decades.
- Atrial natriuretic peptide (ANP) has shown potential in animal models, but clinical trial results have been inconsistent.
Purpose of the Study:
- To evaluate the efficacy and safety of atrial natriuretic peptide (ANP) for the prevention and treatment of acute kidney injury (AKI).
- To analyze benefits and harms associated with different doses of ANP in various clinical scenarios.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
- Searches included CENTRAL, MEDLINE, and EMBASE databases.
- Nineteen RCTs involving 1,861 adult hospitalized patients at risk of or with AKI were analyzed, comparing ANP to control treatments.
Main Results:
- Low-dose ANP was associated with a reduced need for renal replacement therapy (RRT) in prevention (RR 0.32) and treatment (RR 0.54) of AKI.
- Low-dose ANP also shortened hospital and ICU stays in prevention studies.
- High-dose ANP was linked to increased adverse events, including hypotension and arrhythmias, particularly in treatment settings.
Conclusions:
- Low-dose ANP shows promise for preventing AKI and managing post-surgery AKI, meriting further research in these areas.
- ANP did not demonstrate benefits in preventing AKI after major surgery or in treating radiocontrast nephropathy or oliguric AKI.
- While low-dose ANP appears safe for prevention, high-dose ANP in treatment settings carries risks of adverse cardiovascular events.
Background:
Acute kidney injury (AKI) is common in hospitalised patients and is associated with significant morbidity and mortality. Despite recent advances, outcomes have not substantially changed in the last four decades. Atrial natriuretic peptide (ANP) has shown promise in animal studies, however randomised controlled trials (RCTs) have shown inconsistent clinical benefits.
Objectives:
To assess the benefits and harms of ANP for preventing and treating AKI.
Search Strategy:
We searched CENTRAL, MEDLINE and EMBASE and reference lists of retrieved articles.
Selection Criteria:
RCTs that investigated all forms of ANP versus any other treatment in adult hospitalised patients with or "at risk" of AKI.
Data Collection And Analysis:
Results were expressed as risk ratios (RR) with 95% confidence intervals (CI) or mean difference (MD). Outcomes were analysed separately for low and high dose ANP for preventing or treating AKI.
Main Results:
Nineteen studies (11 prevention, 8 treatment; 1,861 participants) were included. There was no difference in mortality between ANP and control in either the low or high dose prevention studies. Low (but not high) dose ANP was associated with a reduced need for RRT in the prevention studies (RR 0.32, 95% CI 0.14 to 0.71). Length of hospital and ICU stay were significantly shorter in the low dose ANP group. For established AKI, there was no difference in mortality with either low or high dose ANP. Low (but not high) dose ANP was associated with a reduction in the need for RRT (RR 0.54, 95% CI 0.30 to 0.98). High dose ANP was associated with more adverse events (hypotension, arrhythmias). After major surgery there was a significant reduction in RRT requirement with ANP in the prevention studies (RR 0.56, 95% CI 0.32 to 0.99), but not in the treatment studies. There was no difference in mortality between ANP and control in either the prevention or treatment studies. There was a reduced need for RRT with low dose ANP in patients undergoing cardiovascular surgery (RR 0.35, 95% CI 0.18 to 0.70). ANP was not associated with outcome improvement in either radiocontrast nephropathy or oliguric AKI.
Authors' Conclusions:
ANP may be associated with improved outcomes when used in low doses for preventing AKI and in managing postsurgery AKI and should be further explored in these two settings. There were no significant adverse events in the prevention studies, however in the high dose ANP treatment studies there were significant increases hypotension and arrhythmias.
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