B‐Natriuretic Peptide for the Prevention of Radiocontrast‐Induced Nephropathy

Abstract

BACKGROUND: The hypothesis of the study was that infusion of B-natriuretic peptide (BNP), by increasing renal vasodilatation and glomerular fi ltration, would reduce the incidence of radiocontrast nephropathy (RCIN) after cardiac catheterization in patients with preexisting renal insuffi ciency. METHODS:The study was a single-center, prospective, randomized, double-blind, placebo-controlled pilot study of 50 patients. Patients with a baseline serum creatinine (SCr) Ͼ 1.5 mg/dL not on dialysis undergoing elective cardiac catheterization with visipaque (nonionic, iso-osmolal contrast) were enrolled. Patients were randomly assigned to receive intravenous BNP or placebo infusion. RCIN was defi ned as SCr increase Ն 0.5 mg/dL at 48 hours post-contrast administration.RESULTS: There were no signifi cant differences in baseline characteristics between the 2 groups. The incidence of RCIN was 3.8% (1 of 26) in the BNP group versus 12.5% (3 of 24) in the placebo group (p ϭ 0.340). None of the patients who developed RCIN required renal replacement therapy, and all their SCr values returned to baseline on posthospital follow-up. On logistic regression only the baseline SCr was an independent predictor of RCIN.CONCLUSIONS: BNP infusion shows a nonsignifi cant trend of reduction in the incidence of RCIN in patients with chronic renal insuffi ciency undergoing elective cardiac catheterization. Further large-scale trials are needed to determine the usefulness of BNP infusion to prevent RCIN.