Mori Yosuke, Kamada Takaaki, Ochiai Ryoichi
From the Department of Anesthesia, Kawasaki Saiwai Hospital, Saiwai, Kawasaki, Kanagawa (YM, TK), Department of Anesthesiology, School of Medicine, Toho University, Oota-ku, Tokyo (RO), Japan.
Eur J Anaesthesiol. 2014 Jul;31(7):381-7. doi: 10.1097/EJA.0000000000000035.
Acute kidney injury (AKI) after surgery is associated with an increased risk of adverse events and death. Atrial natriuretic peptide (ANP) dilates the preglomerular renal arteries and inhibits the renin-angiotensin axis. A low-dose ANP infusion increases glomerular filtration rate after cardiovascular surgery, but it is not known whether it reduces the incidence of AKI or the mortality rate.
To evaluate whether an intravenous ANP infusion prevents AKI in patients undergoing aortic arch surgery requiring hypothermic circulatory arrest.
A randomised controlled study.
Operating room and intensive care unit at Kawasaki Saiwai Hospital, Kanagawa, Japan.
Forty-two patients with normal preoperative renal function undergoing elective repair of an aortic arch aneurysm.
Patients were assigned randomly to receive a fixed dose of ANP (0.0125 μg (-1) kg(-1) min) or placebo. The infusion was started after induction of anaesthesia and continued for 24 h postoperatively.
The primary end-point was the incidence of AKI within 48 h after surgery.
AKI developed in 30% of patients who received ANP compared with 73% of patients who received placebo (P = 0.014). Intraoperative urine output was almost 1 l greater in patients who received ANP (1865 ± 1299 versus 991 ± 480 ml in the control group, P = 0.005). However, there were no differences in mean arterial pressure or number of episodes of hypotension between the groups. Length of hospital and intensive care stays were not significantly different, nor was there a difference in 30-day mortality. No patients required haemodialysis or continuous renal replacement therapy.
We found that an intravenous infusion of ANP at 0.0125 μg kg(-1) min(-1) is an effective intervention for reducing the incidence of postoperative AKI, and appears to afford a degree of renal protection during and after cardiovascular surgery.
Kawasaki ANP trial, UMIN Clinical Trials Registry ID: UMIN000011650.
术后急性肾损伤（AKI）与不良事件及死亡风险增加相关。心房利钠肽（ANP）可扩张肾动脉前小动脉并抑制肾素 - 血管紧张素轴。心血管手术后，低剂量输注ANP可增加肾小球滤过率，但尚不清楚其是否能降低AKI发生率或死亡率。
评估静脉输注ANP能否预防需要低温循环停止的主动脉弓手术患者发生AKI。
一项随机对照研究。
日本神奈川县川崎赛外医院手术室及重症监护病房。
42例术前肾功能正常、择期行主动脉弓动脉瘤修复术的患者。
患者被随机分配接受固定剂量的ANP（0.0125μg·kg⁻¹·min⁻¹）或安慰剂。输注在麻醉诱导后开始，术后持续24小时。
主要终点为术后48小时内AKI的发生率。
接受ANP的患者中30%发生AKI，而接受安慰剂的患者中这一比例为73%（P = 0.014）。接受ANP的患者术中尿量几乎多1升（分别为1865±1299毫升和对照组的991±480毫升，P = 0.005）。然而，两组间平均动脉压或低血压发作次数无差异。住院时间和重症监护病房停留时间无显著差异，30天死亡率也无差异。无患者需要血液透析或连续性肾脏替代治疗。
我们发现，以0.0125μg·kg⁻¹·min⁻¹的剂量静脉输注ANP是降低术后AKI发生率的有效干预措施，并且在心血管手术期间及术后似乎能提供一定程度的肾脏保护。
川崎ANP试验，UMIN临床试验注册编号：UMIN000011650。
