• Yosuke Mori, Takaaki Kamada, and Ryoichi Ochiai.
• From the Department of Anesthesia, Kawasaki Saiwai Hospital, Saiwai, Kawasaki, Kanagawa (YM, TK), Department of Anesthesiology, School of Medicine, Toho University, Oota-ku, Tokyo (RO), Japan.
• Eur J Anaesthesiol. 2014 Jul 1;31(7):381-7.

BackgroundAcute kidney injury (AKI) after surgery is associated with an increased risk of adverse events and death. Atrial natriuretic peptide (ANP) dilates the preglomerular renal arteries and inhibits the renin-angiotensin axis. A low-dose ANP infusion increases glomerular filtration rate after cardiovascular surgery, but it is not known whether it reduces the incidence of AKI or the mortality rate.ObjectiveTo evaluate whether an intravenous ANP infusion prevents AKI in patients undergoing aortic arch surgery requiring hypothermic circulatory arrest.DesignA randomised controlled study.SettingOperating room and intensive care unit at Kawasaki Saiwai Hospital, Kanagawa, Japan.PatientsForty-two patients with normal preoperative renal function undergoing elective repair of an aortic arch aneurysm.InterventionPatients were assigned randomly to receive a fixed dose of ANP (0.0125 μg (-1) kg(-1)  min) or placebo. The infusion was started after induction of anaesthesia and continued for 24  h postoperatively.Main Outcome MeasuresThe primary end-point was the incidence of AKI within 48 h after surgery.ResultsAKI developed in 30% of patients who received ANP compared with 73% of patients who received placebo (P = 0.014). Intraoperative urine output was almost 1 l greater in patients who received ANP (1865 ± 1299 versus 991 ± 480  ml in the control group, P = 0.005). However, there were no differences in mean arterial pressure or number of episodes of hypotension between the groups. Length of hospital and intensive care stays were not significantly different, nor was there a difference in 30-day mortality. No patients required haemodialysis or continuous renal replacement therapy.ConclusionWe found that an intravenous infusion of ANP at 0.0125  μg  kg(-1)  min(-1) is an effective intervention for reducing the incidence of postoperative AKI, and appears to afford a degree of renal protection during and after cardiovascular surgery.Trial RegistrationKawasaki ANP trial, UMIN Clinical Trials Registry ID: UMIN000011650.

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