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CLINICAL RESEARCH: CLINICAL TRIAL

Influence of Continuous Infusion of Low-Dose Human Atrial Natriuretic Peptide on Renal Function During Cardiac Surgery

A Randomized Controlled Study

Akira Sezai, MD, PhD^_*,_*, Mitsumasa Hata, MD, PhD^_*, Tetsuya Niino, MD, PhD^_*, Isamu Yoshitake, MD, PhD^_*, Satoshi Unosawa, MD, PhD^_*, Shinji Wakui, MD, PhD^_*, Shunji Osaka, MD, PhD^_*, Tadateru Takayama, MD, PhD, Yuji Kasamaki, MD, PhD, Atsushi Hirayama, MD, PhD and Kazutomo Minami, MD, PhD^_*

^_* Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan

Manuscript received January 8, 2009; revised manuscript received April 29, 2009, accepted May 25, 2009.

^_* Reprint requests and correspondence: Dr. Akira Sezai, The Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi Itabashi-ku, Tokyo 173-8610, Japan (Email: asezai{at}med.nihon-u.ac.jp).

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 µg/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)

Key Words: human atrial natriuretic peptide • cardiopulmonary bypass • cardiac surgery • renal failure • coronary artery bypass grafting

Abbreviations and Acronyms   %Cr = percent increase of creatinine   BNP = brain natriuretic peptide   CABG = coronary artery bypass grafting   Ccr = creatinine clearance   CH20 = free water clearance   CPB = cardiopulmonary bypass   Cr = creatinine   FENa = fractional sodium excretion   hANP = human atrial natriuretic peptide   ICU = intensive care unit   OPCAB = off-pump coronary artery bypass   RAAS = renin-angiotensin-aldosterone system   RFI = renal failure index

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