• Akira Sezai, Mitsumasa Hata, Tetsuya Niino, Isamu Yoshitake, Satoshi Unosawa, Shinji Wakui, Shunji Osaka, Tadateru Takayama, Yuji Kasamaki, Atsushi Hirayama, and Kazutomo Minami.
• Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. asezai@med.nihon-u.ac.jp
• J. Am. Coll. Cardiol. 2009 Sep 15;54(12):1058-64.

ObjectivesThe purpose of this study was to determine the effect of human atrial natriuretic peptide (hANP) in patients who underwent coronary artery bypass grafting (CABG) on renal function.BackgroundAcute renal failure after cardiac surgery is associated with high morbidity and mortality.MethodsA total of 504 patients who underwent CABG were divided into 2 groups: 1 group received hANP at 0.02 microg/kg/min from the start of cardiopulmonary bypass (hANP group), and 1 group did not receive hANP (placebo group). Various parameters were measured before and after surgery.ResultsThere was no difference in mortality between the 2 groups, but post-operative complications were less frequent in the hANP group (p = 0.0208). In the hANP group, serum creatinine (Cr) was significantly lower and urinary Cr and Cr clearance were significantly higher from post-operative day 1 to week 1. The maximum post-operative Cr level and percent increase of Cr were significantly lower in the hANP group (p < 0.0001). Patients with Cr exceeding 2.0 mg/dl included 1 in the hANP group and 8 in the placebo group, showing a significant difference (p = 0.0374). Four patients in the placebo group and none in the hANP group required hemodialysis, but the difference was not statistically significant.ConclusionsContinuous infusion of low-dose hANP from the start of cardiopulmonary bypass effectively maintained post-operative renal function. Infusion of hANP prevents early post-operative acute renal failure and helps to achieve safer cardiac surgery. (Clinical Trial Registration NumberUMIN000001440).

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