Chieko Mitaka1, Tetsu Ohnuma2, Takanori Murayama3, Fumio Kunimoto4, Michio Nagashima5, Tetsuhiro Takei6, Naoya Iguchi7, Makoto Tomita8. 1. Department of Anesthesiology, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Anesthesiology and Pain Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan,. Electronic address: c.mitaka.icu@tmd.ac.jp. 2. Intensive Care Unit, Department of Anesthesiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Ohmiya-ku, Saitama 330-8503, Japan. Electronic address: tetsu.fe3@gmail.com. 3. Intensive Care Unit, Department of Anesthesiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Ohmiya-ku, Saitama 330-8503, Japan. Electronic address: takanori@omiya.jichi.ac.jp. 4. Intensive Care Unit, Gunma University Hospital, 3-39-15 Shouwa, Maebashi, Gunma 371-8511, Japan. Electronic address: kunimoto@gunma-u.ac.jp. 5. Intensive Care Unit, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa 231-8682, Japan. Electronic address: nagamic00@gmail.com. 6. Intensive Care Unit, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa 231-8682, Japan. Electronic address: takei.icu@yokohama.jrc.or.jp. 7. Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: iguchi@hp-icu.med.osaka-u.ac.jp. 8. Clinical Research Center, Tokyo Medical and Dental University Hospital of Medicine 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Electronic address: tomita.crc@tmd.ac.jp.
Abstract
PURPOSE: To evaluate the effects of atrial natriuretic peptide (ANP) on renal function and medical costs in patients with acute kidney injury (AKI) associated with cardiac surgery. MATERIALS AND METHODS: The Japanese trial for AKI in Post-cardiovascular surgery patients by ANP (JAPAN) was a prospective, multicenter, randomized, double-blind, placebo-controlled study conducted in 11 hospitals in Japan. Acute kidney injury was defined as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours. The patients were randomly assigned to receive ANP (0.02 μg kg-1 min-1) or placebo. The primary end point was a change in renal function. The secondary end points were a need for renal replacement therapy, the lengths of intensive care unit and hospital stays, and medical costs incurred over the 90-day follow-up. RESULTS: Of the 77 randomized patients, 37 were in the ANP group and 40 were in theplacebo group. Although ANP significantly (P = .018) increased urine output, it did not significantly improve renal function compared with placebo. There were no significant differences between the groups in the renal replacement therapy rate, the lengths of the intensive care unit and hospital stays, or medical costs. CONCLUSION: Atrial natriuretic peptide infusion did not show a renoprotective effect or cost-saving effect in the treatment of cardiac surgery-associated AKI.
RCT Entities:
PURPOSE: To evaluate the effects of atrial natriuretic peptide (ANP) on renal function and medical costs in patients with acute kidney injury (AKI) associated with cardiac surgery. MATERIALS AND METHODS: The Japanese trial for AKI in Post-cardiovascular surgery patients by ANP (JAPAN) was a prospective, multicenter, randomized, double-blind, placebo-controlled study conducted in 11 hospitals in Japan. Acute kidney injury was defined as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours. The patients were randomly assigned to receive ANP (0.02 μg kg-1 min-1) or placebo. The primary end point was a change in renal function. The secondary end points were a need for renal replacement therapy, the lengths of intensive care unit and hospital stays, and medical costs incurred over the 90-day follow-up. RESULTS: Of the 77 randomized patients, 37 were in the ANP group and 40 were in the placebo group. Although ANP significantly (P = .018) increased urine output, it did not significantly improve renal function compared with placebo. There were no significant differences between the groups in the renal replacement therapy rate, the lengths of the intensive care unit and hospital stays, or medical costs. CONCLUSION: Atrial natriuretic peptide infusion did not show a renoprotective effect or cost-saving effect in the treatment of cardiac surgery-associated AKI.
Authors: Mitra K Nadim; Lui G Forni; Azra Bihorac; Charles Hobson; Jay L Koyner; Andrew Shaw; George J Arnaoutakis; Xiaoqiang Ding; Daniel T Engelman; Hrvoje Gasparovic; Vladimir Gasparovic; Charles A Herzog; Kianoush Kashani; Nevin Katz; Kathleen D Liu; Ravindra L Mehta; Marlies Ostermann; Neesh Pannu; Peter Pickkers; Susanna Price; Zaccaria Ricci; Jeffrey B Rich; Lokeswara R Sajja; Fred A Weaver; Alexander Zarbock; Claudio Ronco; John A Kellum Journal: J Am Heart Assoc Date: 2018-06-01 Impact factor: 5.501