Natriuretic Peptides in the Management of Solid Organ Transplantation Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis

Abstract

Randomized controlled trials involving natriuretic peptide administration in solid organ transplantation setting have shown inconsistent effects for renal endpoints. We conducted a systematic review and meta-analysis of these trials to ascertain the role of natriuretic peptides in the management of solid organ transplantation associated acute kidney injury (AKI). MEDLINE, EMBASE, and Google scholar were searched independently by two authors for randomized trials evaluating renal effects of natriuretic peptides in solid organ transplantation settings. Two reviewers independently assessed the studies for eligibility and extracted the relevant data. The pooled estimate showed that natriuretic peptide administration is associated with a reduction in AKI requiring dialysis (odds ratio = 0.50 [0.26–0.97]), a statistically nonsignificant trend toward improvement in posttransplant creatinine clearance (weighted mean difference = 5.5 mL/min, [−1.3 to 12.2 mL/min]), and reduction in renal replacement requirement duration (weighted mean difference −44.0 hours, [−60.5 to −27.5 hours]). There were no mortality events and no adverse events related to natriuretic peptides. In conclusion, administration of natriuretic peptides in solid organ transplantation may be associated with significant improvements in renal outcomes. These observations need to be confirmed in an adequately powered, prospective multicenter study.

Clinical practice guidelines for the provision of renal service in Hong Kong: General Nephrology

“…While early data suggests a lower incidence of AKI was associated with the use of fenoldopam, data from adequately powered multi‐centre trials with clinically significant endpoints do not support recommending fenoldopam to either prevent or treat AKI, noting in particular the concern of the associated hypotension. The use of atrial natriuretic peptide to prevent or treat AKI is not suggested. (D)Studies demonstrating benefits of recombinant human atrial natriuretic peptide in reduced need for dialysis and improved dialysis‐free survival after cardiac surgery or solid organ transplantation tend to be underpowered, its routine use for the prevention or treatment of AKI cannot be recommended, the concern of hypotension aside The use of off‐pump coronary artery bypass graft in order to prevent post‐operative AKI is not suggested.…”

“…Studies demonstrating benefits of recombinant human atrial natriuretic peptide in reduced need for dialysis and improved dialysis‐free survival after cardiac surgery or solid organ transplantation tend to be underpowered, its routine use for the prevention or treatment of AKI cannot be recommended, the concern of hypotension aside …”

10 tips for intensive care management of transplanted heart patients

“…In early AKI post-HTx, infusion of low-dose (50 ng/kg/min) atrial natriuretic peptide (ANP) increases renal blood flow and glomerular filtration rate and decreases the incidence of dialysis in AKI after cardiac surgery. A meta-analysis showed that for solid organ (liver, heart, kidney) transplantation-associated AKI, ANP reduces the need for dialysis ( Table 1, tip 9) [12].…”