• Tomoko Fujii, Tosiya Sato, Shigehiko Uchino, Kent Doi, Taku Iwami, Takashi Kawamura, and JAKID study group.
• Department of Epidemiology and Preventive Medicine, Kyoto University Graduate School of Medicine. Yoshida Hon-machi, Sakyo-ku, Kyoto, Japan; Japan Society for the Promotion of Science. 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, Japan. Electronic address: tofujii-tky@umin.net.
• J Crit Care. 2019 Jun 1; 51: 229-235.

PurposeAcute kidney injury (AKI) is common in the intensive care unit (ICU). Selected clinical studies have implied human atrial natriuretic peptide (hANP) improves renal function; however, the treatment effects for AKI are unclear.MethodsA multicenter prospective observational study in 13 Japanese ICUs. The effects of hANP were estimated by the standardized mortality ratio weighted analyses of generalized linear models using propensity scores. The primary outcome was renal replacement therapy (RRT) or death in the ICU.ResultsOf 904 patients with AKI, 63 received hANP as a treatment for AKI. The primary outcome occurred in 20.5% (185/904). HANP did not reduce the risk of RRT or death in the ICU (risk ratio 1.12, 95% confidence interval [CI] 0.74 to 1.69) and was associated with a lower mean arterial pressure (β -3.8 mmHg, 95%CI -7.6 to -0.1), a longer hospital length of stay (β 12.0 days, 95%CI 1.2 to 22.8) and a lower eGFR at hospital discharge (β -10.4 mL/min/m2, 95%CI -19.1 to -1.7). No beneficial effect was observed in subgroups of cardiovascular surgery, sepsis, nor chronic kidney disease.ConclusionsIn critically ill patients with AKI, the treatment effect of hANP was not evident on dialysis-free survival in the ICU.Copyright © 2018 Elsevier Inc. All rights reserved.

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