Atrial natriuretic factor in oliguric acute renal failure
Atrial natriuretic factor in oliguric acute renal failure
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DOI：
10.1053/ajkd.2000.17659
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发表时间：
2000-10-01
影响因子：
13.2
通讯作者：
Allgren, RL
中科院分区：
文献类型：
--
作者：
Lewis, J;Salem, MM;Allgren, RL
心房利钠肽（ANP）是一种由心房合成的内源性激素，在多种急性肾功能衰竭动物模型中已被证明可改善肾功能。在最近的一项504例急性肾小管坏死（少尿和非少尿）患者的多中心临床试验中，ANP仅在少尿患者中减少了透析需求。在本研究中，222例少尿型急性肾功能衰竭患者被纳入一项多中心、随机、双盲、安慰剂对照试验，旨在前瞻性评估ANP与安慰剂相比的安全性和有效性。受试者随机接受24小时ANP（anaritide，0.2 μ g/kg/min;人ANP的合成形式）或安慰剂输注治疗。随访60天，观察透析情况和死亡情况。主要疗效终点为第21天的无透析生存率，ANP组的无透析生存率为21%，安慰剂组为15%（P = 0.22）。在研究的第14天，ANP组和安慰剂组分别有64%和77%的患者接受了透析（P = 0.054），另外9例患者ANP组7例; 2例患者，安慰剂组）需要透析但未接受透析。尽管存在趋势，在这些患有少尿急性肾衰竭的受试者中，ANP在无透析存活率或减少透析方面没有统计学显著的有益效果。ANP组和安慰剂组第60天的死亡率分别为60%和56%（P = 0.541）。在研究药物输注期间，ANP组108例患者中有102例（95%）收缩压低于90 mm Hg，安慰剂组114例患者中有63例（55%）收缩压低于90 mm Hg（P < 0.001）。收缩压的最大绝对下降在阿那立肽组显著大于安慰剂组（33.6对23.9 mm Hg; P < 0.001）。这一特征明确的少尿型急性肾衰竭人群的总体发病率和死亡率较高，（C）2000年由国家肾脏基金会，Inc.
Atrial natriuretic peptide (ANP), an endogenous hormone synthesized by the cardiac atria, has been shown to improve renal function in multiple animal models of acute renal failure, In a recent multicenter clinical trial of 504 patients with acute tubular necrosis (oliguric and nonoliguric), ANP decreased the need for dialysis only in the oliguric patients. In the present study, 222 patients with oliguric acute renal failure were enrolled into a multicenter, randomized, double-blind, placebo-controlled trial designed to assess prospectively the safety and efficacy of ANP compared with placebo. Subjects were randomized to treatment with a 24-hour infusion of ANP (anaritide, 0.2 mu g/kg/min; synthetic form of human ANP) or placebo. Dialysis and mortality status were followed up for 60 days. The primary efficacy end point was dialysis-free survival through day 21, Dialysis-free survival rates were 21% in the ANP group and 15% in the placebo group (P = 0.22). By day 14 of the study, 64% and 77% of the ANP and placebo groups had undergone dialysis, respectively (P = 0.054), and 9 additional patients (7 patients, ANP group; 2 patients, placebo group) needed dialysis but did not receive it. Although a trend was present, there was no statistically significant beneficial effect of ANP in dialysis-free survival or reduction in dialysis in these subjects with oliguric acute renal failure. Mortality rates through day 60 were 60% versus 56% in the ANP and placebo groups, respectively (P = 0.541), One hundred two of 108 (95%) versus 63 of 114 (55%) patients in the ANP and placebo groups had systolic blood pressures less than 90 mm Hg during the study-drug infusion (P < 0.001). The maximal absolute decrease in systolic blood pressure was significantly greater in the anaritide group than placebo group (33.6 versus 23.9 mm Hg; P < 0.001). This well-characterized population with oliguric acute renal failure had an overall high morbidity and mortality, (C) 2000 by the National Kidney Foundation, Inc.