• Akira Sezai, Mitsumasa Hata, Tetsuya Niino, Isamu Yoshitake, Satoshi Unosawa, Shinji Wakui, Haruka Kimura, Motomi Shiono, Tadateru Takayama, and Atsushi Hirayama.
• Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. asezai.med@gmail.com
• J. Am. Coll. Cardiol. 2011 Aug 23;58(9):897-903.

ObjectivesThe purpose of this comparative study is to prove the efficacy of the human atrial natriuretic peptide (hANP) in patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery (CABG).BackgroundCKD is an important risk factor for cardiac surgery.MethodsThis was a randomized controlled study of 303 patients with CKD who underwent CABG, and were divided into a group who received carperitide infusion and another group without carperitide. The primary endpoints were: 1) the post-operative dialysis-free rate; and 2) serum creatinine (sCr) and estimated glomerular filtration rate. The secondary endpoints were: 1) the early post-operative outcome; 2) outcome at 1 year post-operatively; 3) the maximum sCr, the rate of increase of sCr, and an increase of sCr by ≥ 0.3 mg/dl compared with the pre-operative value; and 4) ANP and cyclic-guanosine monophosphate levels.ResultsThe post-operative sCr was significantly lower in the hANP group not only in the post-operative acute stage but also in the first year. The maximum Cr and Cr increase rate were significantly lower in the hANP group (p = 0.00665, p < 0.0001). There was no difference in mortality rate in the first year post-operatively, and fewer cardiac events and patients going on dialysis were found in the hANP group (p < 0.0001 and p = 0.0014, respectively).ConclusionsIn the post-operative acute stage, carperitide showed cardiorenal protective effects that prevented post-operative cardiac events and initiation of dialysis. Thus, perioperative infusion of low-dose carperitide may have a significant role in management of patients with renal dysfunction undergoing on-pump CABG. (Effectiveness of hANP for Cardiac Surgery in Patients With Moderate to Severe Preoperative Renal Dysfunction Without Dialysis [NU-HIT for CRF]; UMIN000001462).Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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