Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 58, Issue 9, Pages 897-903Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2011.03.056
Keywords
atrial natriuretic peptide; cardiac surgery; carperitide; chronic kidney disease; natriuretic peptide
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Funding
- Japanese Ministry of Education, Culture, Sports, Science and Technology [21591805]
- Nihon University School of Medicine
- Nihon University School of Medicine Foundation
- Grants-in-Aid for Scientific Research [21591805] Funding Source: KAKEN
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Objectives The purpose of this comparative study is to prove the efficacy of the human atrial natriuretic peptide (hANP) in patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery (CABG). Background CKD is an important risk factor for cardiac surgery. Methods This was a randomized controlled study of 303 patients with CKD who underwent CABG, and were divided into a group who received carperitide infusion and another group without carperitide. The primary endpoints were: 1) the post-operative dialysis-free rate; and 2) serum creatinine (sCr) and estimated glomerular filtration rate. The secondary endpoints were: 1) the early post-operative outcome; 2) outcome at 1 year post-operatively; 3) the maximum sCr, the rate of increase of sCr, and an increase of sCr by >= 0.3 mg/dl compared with the pre-operative value; and 4) ANP and cyclic-guanosine monophosphate levels. Results The post-operative sCr was significantly lower in the hANP group not only in the post-operative acute stage but also in the first year. The maximum Cr and Cr increase rate were significantly lower in the hANP group (p = 0.00665, p < 0.0001). There was no difference in mortality rate in the first year post-operatively, and fewer cardiac events and patients going on dialysis were found in the hANP group (p < 0.0001 and p = 0.0014, respectively). Conclusions In the post-operative acute stage, carperitide showed cardiorenal protective effects that prevented post-operative cardiac events and initiation of dialysis. Thus, perioperative infusion of low-dose carperitide may have a significant role in management of patients with renal dysfunction undergoing on-pump CABG. (Effectiveness of hANP for Cardiac Surgery in Patients With Moderate to Severe Preoperative Renal Dysfunction Without Dialysis [NU-HIT for CRF]; UMIN000001462) (J Am Coll Cardiol 2011; 58: 897-903) (C) 2011 by the American College of Cardiology Foundation
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