Recombinant human atrial natriuretic peptide in ischemic acute renal failure: A randomized placebo-controlled trial*
Recombinant human atrial natriuretic peptide in ischemic acute renal failure: A randomized placebo-controlled trial*
复制标题
重组人心钠肽治疗缺血性急性肾衰竭：一项随机安慰剂对照试验*
DOI：
10.1097/01.ccm.0000128560.57111.cd
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发表时间：
2004
影响因子：
8.8
通讯作者：
S. Ricksten
中科院分区：
文献类型：
--
作者：
K. Swärd;F. Valsson;Per Odencrants;O. Samuelsson;S. Ricksten
目的：急性肾衰竭与显着的发病率和死亡率相关。透析的需要是复杂心脏手术后早期死亡的独立危险因素。人心房钠尿肽（h-ANP）是一种有效的内源性利钠和利尿物质。外源性给予 h-ANP 可增加临床急性肾功能衰竭的肾小球滤过率和肾血流量。我们研究了 h-ANP 对缺血性急性肾衰竭肾脏结局的影响。设计：一项前瞻性、双盲、随机、安慰剂对照研究。地点：两个三级护理中心的心胸重症监护室。患者：61 名术前肾功能正常的患者，患有心脏手术后心力衰竭，需要显着的正性肌力和血管活性支持。干预措施：当血清肌酐较基线增加> 50%时，患者被随机分配接受重组h-ANP（50 ng·kg−1·min−1）或安慰剂的连续输注。 h-ANP/安慰剂治疗持续进行，直至血清肌酐降至纳入触发值以下或患者满足预定的透析标准。测量和主要结果：主要结果变量是治疗开始后第 21 天或之前的透析。次要肾脏结果变量是第 21 天的无透析生存期和肌酐清除率。 29 名患者接受 h-ANP 治疗，30 名患者接受安慰剂治疗。 h-ANP 组有 6 名患者 (21%)，而安慰剂组有 14 名患者 (47%) 在第 21 天之前或第 21 天需要透析（风险比，0.28；95% 置信区间，0.10–0.73；p = 0.009）。 h-ANP 组有 8 名 (28%) 患者，而安慰剂组有 17 名 (57%) 患者在第 21 天之前或第 21 天时发生联合终点透析或死亡（风险比，0.35；95% 置信区间，0.14–0.82；p = .017）。与安慰剂相比，h-ANP 改善了肌酐清除率 (p = .040)。结论：以50 ng·kg−1·min−1的速度输注h-ANP可增强肾脏排泄功能，降低透析概率，并提高复杂心脏手术后早期缺血性急性肾功能不全患者的无透析生存率。
Objective:Acute renal failure is associated with significant morbidity and mortality rates. Need for dialysis is an independent risk factor for early mortality after complicated cardiac surgery. Human atrial natriuretic peptide (h-ANP) is a potent endogenous natriuretic and diuretic substance. Exogenous administration of h-ANP increases glomerular filtration rate and renal blood flow in clinical acute renal failure. We have studied the effects of h-ANP on renal outcome in ischemic acute renal failure. Design:A prospective, double-blind, randomized, placebo-controlled study. Setting:Cardiothoracic intensive care units of two tertiary care centers. Patients:Sixty-one patients with normal preoperative renal function suffering from postcardiac surgical heart failure requiring significant inotropic and vasoactive support. Interventions:The patients were randomized to receive a continuous infusion of either recombinant h-ANP (50 ng·kg−1·min−1) or placebo when serum creatinine increased by >50% from baseline. The treatment with h-ANP/placebo continued until serum creatinine decreased below the trigger value for inclusion or the patients fulfilled predefined criteria for dialysis. Measurements and Main Results:The primary outcome variable was dialysis on or before day 21 after the start of treatment. Secondary renal outcome variables were dialysis-free survival at day 21 and creatinine clearance. Twenty-nine patients were assigned h-ANP and 30 placebo. Six (21%) patients in the h-ANP group compared with 14 (47%) in the placebo group needed dialysis before or at day 21 (hazard ratio, 0.28; 95% confidence interval, 0.10–0.73; p = .009). Eight (28%) patients in the h-ANP group compared with 17 (57%) in the placebo group suffered from the combined end point dialysis or death before or at day 21 (hazard ratio, 0.35; 95% confidence interval, 0.14–0.82; p = .017). h-ANP improved creatinine clearance in contrast to placebo (p = .040). Conclusions:Infusion of h-ANP at a rate of 50 ng·kg−1·min−1 enhances renal excretory function, decreases the probability of dialysis, and improves dialysis-free survival in early, ischemic acute renal dysfunction after complicated cardiac surgery.