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General Thoracic and Cardiovascular Surgery

, Volume 60, Issue 1, pp 21–30 | Cite as

Multicenter trial of carperitide in patients with renal dysfunction undergoing cardiovascular surgery

  • Kazuki HisatomiEmail author
  • Kiyoyuki Eishi
Original Article

Abstract

Purpose

The aim of this study was to evaluate the efficacy of carperitide in maintaining renal function during intraoperative and postoperative management of patients with renal dysfunction undergoing elective cardiovascular surgery.

Methods

The subjects were 88 patients with a preoperative serum creatinine level ≥1.2 mg/dl who underwent elective cardiovascular surgery using cardiopulmonary bypass. They were prospectively divided into a group that received carperitide from the start of surgery (carperitide group, n = 44) and a group that was not given carperitide (control group, n = 44). Carperitide infusion was initiated at the beginning of surgery and was continued for ≥5 days, with the central dose being 0.02 g/kg/min. The primary endpoint was the serum creatinine level on postoperative day (POD) 3.

Results

The serum creatinine levels on PODs 3, 4, and 7 were significantly lower, and creatinine clearance on PODs 2 and 3 was significantly higher in the carperitide group than in the controls. One patient in the control group and no patient in the carperitide group required continuous hemodiafiltration, but the difference was not statistically significant.

Conclusion

Continuous low-dose infusion of carperitide from the start of cardiovascular surgery maintained renal function in patients with preoperative renal dysfunction.

Key words

Carperitide Renal dysfunction Cardiovascular surgery Creatinine Creatinine clearance 

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References

  1. 1.
    Zanardo G, Michielon P, Paccagnella A, Rosi P, Caló M, Salandin V, et al. Acute renal failure in the patient undergoing cardiac operation: prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 1994;107:1489–1495.PubMedGoogle Scholar
  2. 2.
    Andersson LG, Ekroth R, Bratteby LE, Hallhagen S, Wesslén O. Acute renal failure after coronary surgery: a study of incidence and risk factors in 2009 consecutive patients. J Thorac Cardiovasc Surg 1993;41:237–241.CrossRefGoogle Scholar
  3. 3.
    Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization-The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 1998;128:194–203.PubMedGoogle Scholar
  4. 4.
    Bertolissi M. Prevention of acute renal failure in major vascular surgery. Minerva Anestesiol 1999;65:867–877.PubMedGoogle Scholar
  5. 5.
    Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, et al. Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999;14:1158–1162.PubMedCrossRefGoogle Scholar
  6. 6.
    Corwin HL, Sprague SM, DeLaria GA, Norusis MJ. Acute renal failure associated with cardiac operation: a case control study. J Thorac Cardiovasc Surg 1989;98:1107–1112.PubMedGoogle Scholar
  7. 7.
    Chertow GM, Lazarus JM, Chrisiansen CL, Cook EF, Hammermeister KE, Grover F, et al. Preoperative renal risk stratification. Circulation 1997;95:878–884.PubMedGoogle Scholar
  8. 8.
    Charles EH, Sinan Y, Mark SS, Jesse DS, Curtis GT, Joseph AL, et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation 2009;119:2444–2353.CrossRefGoogle Scholar
  9. 9.
    Block CA, Manning HL. Prevention of acute renal failure in the critically ill. Am J Respir Crit Care Med 2002;165:320–324.PubMedGoogle Scholar
  10. 10.
    Sezai A, Shiono M, Orime Y, Hata H, Hata M, Negishi N, et al. Low-dose continuous infusion of human atrial natriuretic peptide during and after cardiac surgery. Ann Thorac Surg 2000;69:732–738.PubMedCrossRefGoogle Scholar
  11. 11.
    Saito Y, Nakao K, Nishimura K, Sugawara A, Okumura K, Obata K, et al. Clinical application of atrial natriuretic polypeptide in patients with congestive heart failure: beneficial effects of left ventricular function. Circulation 1987;76:115–124.PubMedCrossRefGoogle Scholar
  12. 12.
    Sezai A, Hata M, Niino T, Yoshitake I, Unosawa S, Wakui S, et al Influence of continuous infusion of low-dose human atrial natriuretic peptide on renal function during cardiac surgery. J Am Coll Cardiol 2009;54:1058–1064.PubMedCrossRefGoogle Scholar
  13. 13.
    Lassnigg A, Donner E, Grubhofer, Presterl E, Druml W, Hiesmayr M. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 2000;11:97–104.PubMedGoogle Scholar
  14. 14.
    Kellum JA. Use of dopamine in acute renal failure: a metaanalysis. Crit Care Med 2001;29:1526–1531.PubMedCrossRefGoogle Scholar
  15. 15.
    Sward K, Valsson F, Odencrants P, Samuelsson O, Ricksten SE. Recombinant human atrial natriuretic peptide in ischemic acute renal failure: a randomized placebo-controlled trial. Crit Care Med 2004;32:1310–1315.PubMedCrossRefGoogle Scholar
  16. 16.
    Izumi K, Eishi K, Yamachika S, Hashizume K, Tada S, Yamane K, et al. The efficacy of human atrial natriuretic peptide in patients with renal dysfunction undergoing cardiac surgery. Ann Thorac Cardiovasc Surg 2008;14:294–302.PubMedGoogle Scholar
  17. 17.
    Valsson F, Ricksten SE, Hedner T, Lundin S. Effects of arterial natriuretic peptide on acute renal impairment in patients with heart failure after cardiac surgery. Intensive Care Med 1996;10:230–236.CrossRefGoogle Scholar
  18. 18.
    Rahman SN, Kim GE, Mathew AS, Goldberg CA, Allgren R, Schrier RW, et al. Effects of arterial natriuretic peptide in clinical acute renal failure. Kidney Int 1994;45:1731–1738.PubMedCrossRefGoogle Scholar
  19. 19.
    Sward K, Valsson F, Sellgren J, Ricksten SE. Differential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humans. Intensive Care Med 2005;31:79–85.PubMedCrossRefGoogle Scholar
  20. 20.
    Nigwekar SU, Navaneethan SD, Parikh CR, Hix JK. Atrial natriuretic peptide for preventing and treating acute kidney injury. Cochrane Database Syst Rev 2009;(4):CD006028.Google Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2012

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryNagasaki University HospitalNagasakiJapan

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