Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
J Am Coll Cardiol. 2011 Aug 23;58(9):897-903. doi: 10.1016/j.jacc.2011.03.056.
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).
CKD is an important risk factor for cardiac surgery.
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.
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).
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).
本对比研究旨在证明人心房利钠肽（hANP）在接受冠状动脉旁路移植术（CABG）的慢性肾脏病（CKD）患者中的疗效。
CKD 是心脏手术的重要危险因素。
这是一项纳入 303 例 CKD 患者的随机对照研究，这些患者均接受 CABG，并分为接受 carperitide 输注组和未接受 carperitide 组。主要终点是：1）术后无透析率；2）血清肌酐（sCr）和估算肾小球滤过率（eGFR）。次要终点是：1）术后早期结果；2）术后 1 年结果；3）最大 sCr、sCr 增加率和与术前值相比增加≥0.3mg/dl；4）ANP 和环鸟苷酸水平。
hANP 组术后 sCr 不仅在术后急性期，而且在术后 1 年内均明显较低。hANP 组的最大 Cr 和 Cr 增加率明显较低（p=0.00665，p<0.0001）。术后 1 年内死亡率无差异，hANP 组的心脏事件和需要透析的患者更少（p<0.0001 和 p=0.0014）。
在术后急性期，carperitide 具有心脏肾保护作用，可预防术后心脏事件和透析的启动。因此，围手术期低剂量 carperitide 输注可能在管理接受体外循环 CABG 的肾功能障碍患者方面具有重要作用。（中度至重度术前肾功能障碍且无需透析的心脏手术中人心房利钠肽的有效性[NU-HIT 治疗 CKD]；UMIN000001462）。
