Recombinant human atrial natriuretic peptide in ischemic acute renal failure: A randomized placebo-controlled trial*

Swärd, Kristina; Valsson, Felix; Odencrants, Per; Samuelsson, Ola; Ricksten, Sven‐Erik

doi:10.1097/01.ccm.0000128560.57111.cd

Cited by 213 publications

(135 citation statements)

References 25 publications

(25 reference statements)

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“…Although , the eff ects of ANP on renal oxygenation have not been studied, it is less likely that ANP would impair renal oxygenation because of its preferential action on the preglomerular resistance vessels. Th is is further supported by the fi ndings from a prospective, randomized, blinded trial by Swärd et al, who showed that infusion of ANP enhanced renal excretory function, decreased the probability of dialysis and improved dialysis-free survival in early, ischemic AKI after complicated cardiac surgery [40] (Figs. 5 and 6).…”

Section: Treatment Of Clinical Ischemic Akimentioning

confidence: 59%

Renal Oxygenation in Clinical Acute Kidney Injury

Ricksten¹,

Bragadottir²,

Redfors³

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Renal oxygenation is defi ned as the relationship between renal oxygen delivery (DO 2 ) and renal oxygen consumption (VO 2 ) and it can easily be shown that the inverse of this relationship is equivalent to renal extraction of O 2 (O 2 Ex). An increase in renal O 2 Ex means that renal DO 2 has decreased in relation to renal VO 2 , i. e., renal oxygenation is impaired, and vice versa. When compared to other major organs, renal VO 2 is relatively high, second only to the heart. In sedated, mechanically ventilated patients, renal VO 2 is two-thirds (10 ml/min) that of myocardial oxygen consumption (15 ml/min) (Table 1) [1,2]. Renal blo od fl ow, w hich accounts for approximately 20 % of cardiac output, is three times higher than myocardial blood fl ow in this group of patients. Renal O 2 Ex in the non-failing kidney is therefore low, 10 %, compared with, e.g., the heart, in which O 2 E X is 55 % (Table 1). Determin a nts of renal oxygenationIt is well known from experimental studies that tubular sodium reabsorption is the major determinant of renal VO 2 [3] and tha t under normal physiological conditions, approximately 80 % is used to drive active tubular transport of particularly sodium, but also glucose, amino acids and other solutes. Tubular transport processes are highly load-dependent and it has been shown in experimental studies [4] and in p atients [2,[5][6][7] that the re i s a close linear correlation between glomerular fi ltration rate (GFR), renal sodium reabsorption and renal VO 2 (Fig. 1). Th e fi l tered load of sodium is, thus, an important determi nant of renal VO 2 and maneuvers that decrease GFR and the tubular sodium load act to decrease tubular sodium reabsorption and renal VO 2 , and vice versa [8]. It has b een shown that renal O 2 Ex remains stable over a wide range of renal blood fl ows, which means that changes in renal DO 2 , caused by changes in renal blood fl ow, are directly off set by changes in renal VO 2 [9], i. e., r enal VO 2 is fl ow-dependent. Th us, unlike other organs where increases in blood fl ow will improve oxygenation, increased renal blood fl ow augments GFR and the fi ltered load of sodium, which will increase renal VO 2 . Due to this fl ow-dependency of renal VO 2 , renal oxygenation will re main constant, as long as renal blood fl ow and GFR change in parallel. Regional intrarenal oxygenation and medullary hypoxiaTh e relatively high renal blood fl ow is directed preferentially to the cortex to optimize the fi ltration process and solute reabsorption. In contrast, blood fl ow in the outer medulla is less than 50 % of the cortical blood fl ow to preserve osmotic gradients and to enhance urinary concentration [10]. Th e combi nation of low me dullary perfusion, high oxygen consumption of the medullary thick ascending limbs (mTAL) and the countercurrent exchange of oxygen within the vasa recta, results in a poorly oxygenated outer medulla [11]. Oxygen av ailability is, therefore, low in the outer medulla, which has an oxygen tissue partial pressure (PO 2 ) of 10-20 mm Hg ...

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Section: Treatment Of Clinical Ischemic Akimentioning

confidence: 59%

Renal Oxygenation in Clinical Acute Kidney Injury

Ricksten¹,

Bragadottir²,

Redfors³

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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“…[16][17][18] It is important to note that nesiritide is similar in molecular structure and pharmacologic properties to ANP, which was recently shown to reduce the incidence of dialysis or death in a blinded, prospective, randomized trial in patients with ARF undergoing cardiac surgery. 19 In that trial, ANP was administered on average for 5 days similar to the experience presented here. Of note, both ANP and BNP also reduce endothelin-1, a renal vasoconstrictor, which is elevated following cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] In a randomized, clinical trial, a 5-day infusion of ANP led to a reduction in dialysis or death at 21 days in patients with acute renal failure undergoing cardiac surgery. 19 However, concern for the renal effects of nesiritide has been raised in the population with congestive heart failure. 20,21 Based on anecdotal experience, the Division of Thoracic and Cardiovascular Surgery at the University of Florida started to utilize nesiritide in patients undergoing cardiothoracic surgery in 2002.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of nesiritide on dialysis or all‐cause mortality in patients undergoing cardiothoracic surgery

Beaver¹,

Winterstein²,

Shuster³

et al. 2006

Clinical Cardiology

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SummaryBackground: Natriuretic peptides have been shown to have favorable renal effects. However, recent evidence suggests potential renal side effects in patients with congestive heart failure.Hypothesis: This study examined the effect of nesiritide (human B-type natriuretic peptide) on hemodialysis or death in patients undergoing cardiothoracic surgery.Methods: This retrospective cohort study included patients (n = 940) undergoing nontransplant adult cardiothoracic surgery between July 2001 and February 2004. Patients receiving nesiritide within 3 days after and not before surgery (n = 151) were compared with those not given nesiritide (n = 789) for incidence of hemodialysis or in-hospital death by Day 21 (HD/death). Patients with preexisting dialysis and intraoperative deaths were excluded. Forward inclusion multiple logistic regression was used based on published risk factors for HD/death.Results: Of 940 patients (318 coronary artery bypass graft, 348 valve, and 274 thoracic aorta), 36 required dialysis and 60 patients died (HD/death; n = 77). Adjusted for significant con-

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“…In a RCT of critically ill patients with oliguric AKI, the dialysisfree survival through day 21, percentage of patients undergoing dialysis by day 14, and mortality through day 60 did not differ significantly between patients receiving hANP and placebo [187]. On the other hand, in a small RCT of patients with AKI associated with cardiac surgery who started to receive a continuous infusion of low-dose hANP (50 ng/kg/ min) or placebo immediately after the onset of AKI (SCr levels increased by[50 % from baseline), there was no significant difference in the incidence of hypotensive episodes between the low-dose hANP and placebo groups, but the need for hemodialysis was significantly lower in the low-dose hANP group [188]. In a meta-analysis published in 2009, high-dose hANP did not significantly decrease mortality or the percentages of patients requiring hemodialysis, and was associated with an increased incidence of hypotension [189].…”

Section: Level Of Evidence: Iva Grade Of Recommendation: C2 Rationalementioning

confidence: 99%

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

et al. 2013

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Recombinant human atrial natriuretic peptide in ischemic acute renal failure: A randomized placebo-controlled trial*

Abstract: Infusion of h-ANP at a rate of 50 ng.kg(-1).min(-1) enhances renal excretory function, decreases the probability of dialysis, and improves dialysis-free survival in early, ischemic acute renal dysfunction after complicated cardiac surgery.

Cited by 213 publications

References 25 publications

Renal Oxygenation in Clinical Acute Kidney Injury

Renal Oxygenation in Clinical Acute Kidney Injury

Effectiveness of nesiritide on dialysis or all‐cause mortality in patients undergoing cardiothoracic surgery

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

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