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Table 1 Effects of ANP on hemodynamics, renal function, and other parameters in patients undergoing cardiovascular surgery

From: Cardiovascular and renal effects of carperitide and nesiritide in cardiovascular surgery patients: a systematic review and meta-analysis

Author, year, journal, country

and study type

Patient group

Surgical procedure and dose of ANP

Effects of ANP on hemodynamics, renal function, and other parameters

 

ANP (n)

Control (n)

  

Bergman A, et al. [22], 1996

J Cardiothorac Vasc Anesth,

Sweden, RCT

15

15

Elective CABG on CPB, normal renal function

ANP 7.5 pMol/kg/min, after operation for 3 hrs,

MAP→, HR→, PCWP→, RAP→, CI↓

Urine output↑, inulin clearance↑, FF↑, FENa↑

Hayashida N, et al. [34], 2000

Ann ThoracSurg, Japan, RCT

9

9

Elective mitral valve surgery on CPB

ANP 0.05 μg/kg/min, after initiation of CPB for 6 hrs

PCWP↓, RAP↓, SVR↓, CI↑,

Urine output↑, FENa↑, plasma cGMP↑, plasma BNP↓,

Sezai A, et al. [21], 2000

Ann Thorac Surg, Japan, RCT

20

20

Elective CABG on CPB.

ANP (SBP > 120 mmHg,0.05 μg/kg/min; SBP ≤ 120 mmHg,

0.03 μg/kg/min), after initiation of CPB for 24 hrs

→0.02 μg/kg/min for 4 hrs,

CVP↓, SVRI↓, PVRI↓, plasma cGMP↑,

Urine output↑, GFR↑, renin↓, angiotensin II↓,

aldosterone↓, pleural effusion↓, furosemide↓

Hayashi Y, et al.[32], 2003

ASAIO Journal, Japan, RCT

14

16

Selective open heart operation on CPB

ANP 0.025 μg/kg/min, after CPB for 72 hrs,

CVP↓, MPAP↓, PCWP↓, CI↑,

furosemide↓, KCL↓, renin↓, aldosterone↓

Swärd K, et al. [25], 2004

Crit Care Med, Sweden

RCT

29

30

Cardiac surgery, preoperative normal renal function,

SCr > 50%↑, ANP 50 ng/kg/min→SCr decreased below

the trigger value or RRT

Ccr↑, incidence of renal RRT on day 21 (ANP group 21% versus Control group 47%)↓

RRT-free survival at day 21↑

Sezai A, et al. [23], 2007

Circ J, Japan, RCT

63

61

Emergent CABG on CPB

ANP 0.02 μg/kg/min at the start of CPB→0.01 μg/kg/min

for 12 hrs

Peak CK-MB↓, arrhythmias↓, plasma BNP↓,

furosemide↓, KCL↓

Izumi K, et al. [35], 2008

Ann Thorac Cardiovasc Surg,

Japan, RCT

10

8

Elective cardiac surgery on CPB, SCr ≥ 1.2 mg/dl

ANP 0.02 μg/kg/min, for 5 days or more

Urine output↑, SCr↓, Ccr↑, urinary NAG↓

Mitaka C, et al.[24], 2008

Crit Care Med, Japan

RCT

20

20

Elective abdominal aortic aneurysm repair, SCr < 3 mg/dl

ANP 0.01-0.05 μg/kg/min, before aortic cross clamping

→for 48 hrs

Urine output↑, SCr↓, Ccr↑, BUN↓, urinary NAG/Cr↓, plasma ANP ↑, plasma BNP ↓,

furosemide↓

Sumi K, et al. [33], 2008

J Cardiothorac Vas Anesth,

Japan, RCT

30

15

Infrarenal abdominal aortic aneurysmectomy

ANP 0.02 and 0.05 μg/kg/min, respectively,

5 min after aortic clamping→end of operation

MAP→, MPAP↓, PVRI↓, SVRI→

Sezai A, et al. [26], 2009

J Am Coll Cardiol, Japan

RCT

251

253

Elective CABG on CPB, SCr < 1.3 mg/dl, Ccr ≥ 80 ml/min, ANP 0.02 μg/kg/min, at the start of CPB→0.01 μg/kg/min

for 12 hrs

SCr↓, Ccr↑, SCr > 2.0 mg/dl (ANP group; n = 1, Control group; n = 8), RRT (ANP group; n = 0, Control group;n = 4)

Sezai A, et al. [27], 2010

J Am Coll Cardiol, Japan

RCT

68

65

Cardiac surgery on CPB, LVEF ≤ 35%,

ANP 0.02 μg/kg/min, at the start of CPB→0.01 μg/kg/min

for 12 hrs

LVEF↑, eGFR↑, SCr↓, plasma BNP↓, arrhythmias↓,

mortality (NS), cardiac death-free rate at 5 or 8 years

(ANP group; 98.5%, control group; 85.5%)

  1. AKI, acute kidney injury; ANP, atrial natriuretic peptide; BNP, B-type (or brain) natriuretic peptide; BUN, blood urea nitrogen; CABG, coronary artery bypass graft; cGMP, cyclic guanosine, 3',5'-monophosphate; CI, cardiac index; CPB, cardiopulmonary bypass; CVP, central venous pressure; Ccr, creatinine clearance; eGFR, estimated glomerular filtration rate; FF, filtration fractional; FENa, fractional sodium excretion; GFR, glomerular filtration rate; HR, heart rate; LVEF, left ventricular ejection fraction; MAP, mean arterial pressure; MPAP, mean pulmonary arterial pressure; NAG, N-acetyl-beta-D-glucosaminidase; n, number; NS, not significant; PCWP, pulmonary capillary wedge pressure; PVRI, pulmonary vascular resistance index; RAP, right atrial pressure; RCT, randomized controlled trial; RRT, renal replacement therapy; SCr, serum creatinine; SVR: systemic vascular resistance, SVRI: systemic vascular resistance index.