Atrial Natriuretic Peptide for Management of Acute Kidney Injury: A Systematic Review and Meta-analysis
Atrial Natriuretic Peptide for Management of Acute Kidney Injury: A Systematic Review and Meta-analysis
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DOI：
10.2215/cjn.03780808
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发表时间：
2009-02-01
影响因子：
9.8
通讯作者：
Hix, John K.
中科院分区：
文献类型：
--
作者：
Nigwekar, Sagar U.;Navaneethan, Sankar D.;Hix, John K.
背景和目标：心房利钠肽（ANP）的随机对照试验（RCT）显示对肾脏终点的影响不一致。作者旨在系统地回顾这些试验，以确定ANP在预防和治疗急性肾损伤（阿基）中的益处。设计、设置、参与者和测量：作者检索了MEDLINE、EMBASE和科克伦肾脏健康图书馆，这些文献调查了被认为患有AKI或有阿基风险的成人患者中的ANP。结果：共纳入19项随机对照试验（11项预防，8项治疗），涉及1861例受试者。预防试验的汇总分析显示，ANP组肾脏替代治疗有减少的趋势（OR = 0.45，95%CI，0.21 - 0.99），安全性良好，但死亡率无改善。对于已确诊的阿基的治疗，ANP，特别是高剂量的ANP，与死亡率增加和更多不良事件的趋势相关。大手术后阿基的亚组分析（14项RCT，817例受试者）显示，ANP组的肾脏替代治疗需求显著降低（OR = 0.49，95%CI，0.27 - 0.88）。包括随机对照试验大多是低或中等质量，动力不足的studies.Conclusions：有一个高质量的研究，使任何明确的声明ANP在阿基的作用数量不足。现有文献的分析表明，在接受心血管手术等大手术的患者中，ANP可能与有益的临床效果相关。在这种情况下，应进一步探讨其低剂量使用。
Background and objectives: Randomized controlled trials (RCTs) with atrial natriuretic peptide (ANP) have shown inconsistent effects for renal end-points. The authors aimed to systematically review these trials to ascertain the benefit of ANP in prevention and treatment of acute kidney injury (AKI).Design, setting, participants, & measurements: The authors searched MEDLINE, EMBASE, and Cochrane Renal Health Library that investigated ANP in adult patients considered with or at risk for AKI. Outcomes were analyzed separately for prevention and treatment of AKI.Results: Nineteen RCTs (11 prevention, 8 treatment) involving 1861 participants were included. Pooled analysis of prevention trials showed a trend toward reduction in renal replacement therapy in the ANP group (OR = 0.45, 95% CI, 0.21 to 0.99) and good safety profile, but no improvement in mortality. For the treatment of established AKI, ANP, particularly in high doses, was associated with a trend toward increased mortality and more adverse events. Subgroup analysis of AKI after a major surgery (14 RCTs, 817 participants) showed a significant reduction in renal replacement therapy requirement in the ANP group (OR = 0.49, 95% CI, 0.27 to 0.88). Included RCTs were mostly low- or moderate-quality, underpowered studies.Conclusions: There are an insufficient number of high-quality studies to make any definite statement about the role of ANP in AKI. Analysis of the existing literature suggests ANP might be associated with beneficial clinical effects when administered in patients undergoing major surgery such as cardiovascular surgery. Its use, in low doses, should be explored further in this setting.