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CLINICAL RESEARCH: CONTRAST-INDUCED NEPHROPATHY

Renal Protective Effects and the Prevention of Contrast-Induced Nephropathy by Atrial Natriuretic Peptide

Shuji Morikawa, MD^_*, Takahito Sone, MD^_*, Hideyuki Tsuboi, MD^_*, Hiroaki Mukawa, MD^_*, Itsuro Morishima, MD^_*, Michitaka Uesugi, MD^_*, Yasuhiro Morita, MD^_*,, Yasushi Numaguchi, MD, Kenji Okumura, MD^,_* and Toyoaki Murohara, MD

^_* Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Medical Science of Proteases, Nagoya University School of Medicine, Nagoya, Japan
Cardiovascular Research Medicine, Nagoya University School of Medicine, Nagoya, Japan

Manuscript received June 4, 2008; revised manuscript received September 19, 2008, accepted October 13, 2008.

^_* Reprint requests and correspondence: Dr. Kenji Okumura, Cardiovascular Research Medicine, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan (Email: kenji{at}med.nagoya-u.ac.jp).

Objectives: This study was designed to examine the protective effects of atrial natriuretic peptide (ANP) on contrast-induced nephropathy (CIN) after coronary angiography.

Background: Contrast-induced nephropathy is a common complication after angiography. Some studies have shown that ANP has renal protective effects, but the beneficial effects for CIN prevention remain to be clearly shown.

Methods: In a prospective, controlled, randomized trial in 254 consecutive patients with serum creatinine concentrations of 1.3 mg/dl, patients received either ANP (0.042 µg/kg/min; ANP group, n = 126) or Ringer solution alone (control group, n = 128). Treatment of either type was initiated 4 to 6 h before angiography and continued for 48 h.

Results: There were no significant differences in age, sex, diabetes mellitus, or baseline serum creatinine level between the 2 groups. The prevalence of CIN, defined as a 25% increase in creatinine or an increase in creatinine of 0.5 mg/dl from baseline within 48 h, was significantly lower in the ANP group than in the control group (3.2% vs. 11.7%, respectively; p = 0.015). Multivariate analysis revealed that the use of >155 ml of contrast medium (odds ratio: 6.89; p < 0.001) and ANP treatment (odds ratio: 0.24; p = 0.016) were significant predictors of developing CIN. The incidence of an increase in creatinine of 25% or of 0.5 mg/dl from baseline at 1 month was also significantly lower in the ANP group than in the control group (p = 0.006).

Conclusions: In addition to hydration, ANP administration is effective in the prevention of CIN in patients with chronic renal failure, and the effect was maintained for 1 month.

Key Words: contrast-induced nephropathy • atrial natriuretic peptide • coronary angiography • creatinine • eGFR

Abbreviations and Acronyms   ANP = atrial natriuretic peptide   CI = confidence interval   CIN = contrast-induced nephropathy   eGFR = estimated glomerular filtration rate   LVEF = left ventricular ejection fraction   NAG = N-acetyl-β-D-glucosaminidase   NSAID = nonsteroidal anti-inflammatory drugs

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