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Observational Study
. 2020 Jan 30;21(1):31.
doi: 10.1186/s12882-020-1701-7.

Effect of low-dose atrial natriuretic peptide in critically ill patients with acute kidney injury: a retrospective, single-center study with propensity-score matching

Keita Saito  1 , Shigehiko Uchino  2 , Tomoko Fujii  3   4 , Shinjiro Saito  2 , Masanori Takinami  2 , Shoichi Uezono  5
Affiliations
Observational Study

Effect of low-dose atrial natriuretic peptide in critically ill patients with acute kidney injury: a retrospective, single-center study with propensity-score matching

Keita Saito et al. BMC Nephrol. .

Abstract

Background: Acute kidney injury (AKI) is a major comorbidity in critically ill patients. Low-dose atrial natriuretic peptide (ANP) has been shown to effectively prevent acute kidney injury (AKI), especially in cardiovascular surgery patients. However, its treatment effects for AKI in critically ill patients are unclear.

Methods: This single-center, retrospective, observational study included patients with AKI diagnosed within 7 days after intensive care unit (ICU) admission during the period January 2010 to December 2017. We conducted a propensity-matched analysis to estimate the treatment effect of low-dose carperitide (a recombinant human ANP) on the clinical outcomes. The primary outcome was a composite of death, renal replacement therapy dependence, or no recovery from AKI (defined as an increase of the serum creatinine level to ≥200% of baseline) at hospital discharge.

Results: During the study period, 4479 adult patients were admitted to the ICU. We identified 1374 eligible patients with AKI diagnosed within 7 days after ICU admission. Among these patients, 346 (25.2%) were treated with low-dose carperitide, with an average dose of 0.019 μg kg- 1 min- 1. The primary outcome occurred more often in the treatment group than in the control group (29.7% versus 23.4%, respectively; p = 0.022). After propensity score matching, characteristics of 314 patients from each group were well- balanced. Significant difference of the primary outcome, as seen with the full cohort, was no longer obtained; no benefit of carperitide was detected in the matched cohort (29.0% versus 25.2%; p = 0.281).

Conclusions: Low-dose ANP showed no treatment effect in general critically ill patients who developed AKI.

Keywords: AKI treatment; Atrial natriuretic peptide; Critically ill patients.

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Conflict of interest statement

All authors report no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for study patients. AKI acute kidney injury, ESKD end-stage kidney disease, ICU intensive care unit, KDIGO Kidney Disease: Improving Global Outcomes
Fig. 2
Fig. 2
Box plot for trends in serum creatinine levels at Day 1, Day 2, and Day 3 after AKI diagnosis and at ICU discharge for the full cohort (2a) and propensity-matched cohort (2b). AKI acute kidney injury. Gray box: treatment group, White box: control group
Fig. 3
Fig. 3
Box plot for trends in urinary output at 24 h, 48 h, and 72 h after AKI diagnosis for the full cohort (3a) and propensity-matched cohort (3b). Gray box: treatment group, White box: control group
Fig. 4
Fig. 4
Kaplan-Meier survival curves by the treatment group for the full cohort (4a) and propensity-matched cohort (4b) over 90 days
See this image and copyright information in PMC

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