Early Results of Human Atrial Natriuretic Peptide Infusion in Non-Dialysis Patients with Chronic Kidney Disease Undergoing Isolated Coronary Artery Bypass Grafting: the NU-HIT Trial for CKD-II

Abstract

Background: Chronic kidney disease (CKD) is an important risk factor for cardiac surgery. In the most recently reported NU-HIT trial for CKD with CKD patients underwent coronary artery bypass grafting (CABG) as subjects, carperitide was reported to be effective in terms of renal function. In the present study, a subanalysis was performed on patients registered in the NU-HIT trial for CKD from the standpoint of renin-angiotensin system, natriuresis and renal function. Methods: 303 patients with CKD who underwent isolated CABG were divided into a group that received carperitide infusion and another group without carperitide. The renin activity, angiotensin-II, aldosterone, urine-sodium, urine-creatinine, fractional sodium excretion, renal failure index, and BNP levels. Results: There were significant lower in hANP group than the placebo group, in angiotensin-II at one day postoperatively, and in aldosterone from 0 day to one month postoperatively. FENa was significantly lower in the hANP group at 3 day and one week postoperatively. Conclusions: In on pump isolated CABG patients with CKD, carperitide showed a potent natriuretic action and inhibited the renin-angiotensin system, suggesting that it prevented deterioration of postoperative renal function. Our findings raise new possibilities for the perioperative and postoperative management of patients undergoing surgery with cardiopulmonary bypass.

Efficacy of Carperitide in Hemodialysis Patients Undergoing Cardiac Surgery

“…We have previously performed several prospective trials to investigate the effects of carperitide in non-dialysis patients undergoing cardiac surgery, and we have reported that this drug has a cardioprotective effect, a renoprotective effect, counteracts the adverse influence of cardiopulmonary bypass, inhibits the renin-angiotensin-aldosterone system (RAAS), inhibits left ventricular remodeling, and has an antiarrhythmic effect. [13][14][15][16][17][18][19] With regard to the renoprotective effect of carperitide, we have found both acute and longterm avoidance of dialysis, RAAS inhibition, and a potent natriuretic action in non-dialysis patients with CKD. 16,17) Accordingly, we performed the present retrospective investigation to assess the effectiveness of carperitide in dialysis patients undergoing cardiac surgery.…”

“…[13][14][15][16][17][18][19] With regard to the renoprotective effect of carperitide, we have found both acute and longterm avoidance of dialysis, RAAS inhibition, and a potent natriuretic action in non-dialysis patients with CKD. 16,17) Accordingly, we performed the present retrospective investigation to assess the effectiveness of carperitide in dialysis patients undergoing cardiac surgery.…”

Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement

“…In addition to preoperative severe CKD and cardiac dysfunction, prolonged aortic clamping and non-use of carperitide had an effect on long-term MACCE. Our clinical research on perioperative low-dose infusion of carperitide has demonstrated that this drug compensates for the deficiencies of cardiopulmonary bypass and also provides organ protection, 10,11) with both effects being stronger in high risk patients. 12) Accordingly, administration of carperitide to elderly patients undergoing cardiac surgery could be effective for decreasing postoperative complications and protecting vital organs.…”

Preoperative Estimated Glomerular Filtration Rate is an Independent Predictor of Late Cardiovascular Morbidity after Mitral Valve Surgery

“…Moreover, Carperitide is known to exert cardio and renoprotective effects even in patients with mild to moderate renal dysfunction. 26) It is intriguing to examine whether perioperative Carperitide improves postoperative outcomes in mitral valve surgery.…”