Low-dose atrial natriuretic peptide for prevention or treatment of acute kidney injury: a systematic review and meta-analysis.

Acute Kidney Injury / drug therapy Atrial Natriuretic Factor / pharmacology Hospital Mortality Humans Length of Stay Renal Replacement Therapy / methods Treatment Outcome
Acute kidney injury Atrial natriuretic peptide Carperitide Systematic review Trial sequential analysis hANP

Journal

Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902

Informations de publication

Date de publication:
11 Feb 2019
Historique:
received: 13 07 2018
accepted: 22 01 2019
entrez: 13 2 2019
pubmed: 13 2 2019
medline: 1 10 2019
Statut: epublish

Résumé

Theoretically, atrial natriuretic peptide (ANP), especially low-dose ANP, is beneficial in acute kidney injury (AKI). In this study, we examined whether low-dose ANP is effective in preventing or treating AKI by conducting an updated systematic review for randomized controlled trials (RCTs). We searched the Excerpta Medica database (EMBASE), PubMed, and Cochrane CENTRAL databases for RCTs that compare the effects of low-dose ANP (≤ 50 ng/kg/min) with a placebo or conventional therapy in at-risk patients or patients with AKI. The primary outcome was the incidence of new AKI (in prevention RCTs), while the secondary outcomes were in-hospital mortality rate, renal replacement therapy (RRT) requirement, length of hospital and intensive care unit (ICU) stay, incidence of hypotension, and peak serum creatinine levels. The risk-of-bias was evaluated using the Cochrane Collaboration risk-of-bias tool. Trial sequential analysis (TSA) was used for each outcome of interest. A total of 18 RCTs (16 prevention and two treatment trials) fulfilled our inclusion criteria. In prevention RCTs, the incidence of new AKI was significantly low in the low-dose ANP group (relative risk [RR] = 0.51; 95% confidence interval [CI] = 0.36-0.72; P = 0.0001) compared to the control group. In addition, the low-dose ANP group showed a significantly reduced RRT requirement in both prevention (RR = 0.17; 95% CI = 0.04-0.64; P = 0.009) and treatment (RR = 0.43; 95% CI = 0.20-0.93; P = 0.03) RCTs. Among secondary outcomes, in some cases, low-dose ANP was associated with a reduction in ICU and in-hospital stay. The risk-of-bias assessment and TSA results indicated that the sample sizes and qualities of the RCTs were insufficient to conclude the efficacy of low-dose ANP. Low-dose ANP might be effective in preventing or treating AKI. However, the evidence accumulated so far is not strong enough to demonstrate ANP's beneficial effects. The next step is to elucidate the effects of low-dose ANP by conducting multicenter, high-quality, large-sample RCTs. PROSPERO registry CRD42017068568 . Registered 20 June 2017.

Sections du résumé

BACKGROUND BACKGROUND
Theoretically, atrial natriuretic peptide (ANP), especially low-dose ANP, is beneficial in acute kidney injury (AKI). In this study, we examined whether low-dose ANP is effective in preventing or treating AKI by conducting an updated systematic review for randomized controlled trials (RCTs).
METHOD METHODS
We searched the Excerpta Medica database (EMBASE), PubMed, and Cochrane CENTRAL databases for RCTs that compare the effects of low-dose ANP (≤ 50 ng/kg/min) with a placebo or conventional therapy in at-risk patients or patients with AKI. The primary outcome was the incidence of new AKI (in prevention RCTs), while the secondary outcomes were in-hospital mortality rate, renal replacement therapy (RRT) requirement, length of hospital and intensive care unit (ICU) stay, incidence of hypotension, and peak serum creatinine levels. The risk-of-bias was evaluated using the Cochrane Collaboration risk-of-bias tool. Trial sequential analysis (TSA) was used for each outcome of interest.
RESULTS RESULTS
A total of 18 RCTs (16 prevention and two treatment trials) fulfilled our inclusion criteria. In prevention RCTs, the incidence of new AKI was significantly low in the low-dose ANP group (relative risk [RR] = 0.51; 95% confidence interval [CI] = 0.36-0.72; P = 0.0001) compared to the control group. In addition, the low-dose ANP group showed a significantly reduced RRT requirement in both prevention (RR = 0.17; 95% CI = 0.04-0.64; P = 0.009) and treatment (RR = 0.43; 95% CI = 0.20-0.93; P = 0.03) RCTs. Among secondary outcomes, in some cases, low-dose ANP was associated with a reduction in ICU and in-hospital stay. The risk-of-bias assessment and TSA results indicated that the sample sizes and qualities of the RCTs were insufficient to conclude the efficacy of low-dose ANP.
CONCLUSION CONCLUSIONS
Low-dose ANP might be effective in preventing or treating AKI. However, the evidence accumulated so far is not strong enough to demonstrate ANP's beneficial effects. The next step is to elucidate the effects of low-dose ANP by conducting multicenter, high-quality, large-sample RCTs.
TRIAL REGISTRATION BACKGROUND
PROSPERO registry CRD42017068568 . Registered 20 June 2017.

Identifiants

DOI: 10.1186/s13054-019-2330-z PMID: 30744687 PMC: PMC6371622
pubmed: 30744687
doi: 10.1186/s13054-019-2330-z
pii: 10.1186/s13054-019-2330-z
pmc: PMC6371622
doi:

Substances chimiques

Atrial Natriuretic Factor 85637-73-6

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

41

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Auteurs

Hiroyuki Yamada (H)

Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. hyamada@kuhp.kyoto-u.ac.jp.
ORCID: 0000-0002-5167-3147

Kent Doi (K)

Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.

Tatsuo Tsukamoto (T)

Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan.

Hideyasu Kiyomoto (H)

Division of Integrated Nephrology and Telemedicine, Department of Community Support, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

Kazuto Yamashita (K)

Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Motoko Yanagita (M)

Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.

Yoshio Terada (Y)

Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Nankoku, Japan.

Kiyoshi Mori (K)

Department of Nephrology and Kidney Research, Center for Public Health, Shizuoka General Hospital, Shizuoka, Japan. kiyoshimori2001@gmail.com.
Department of Molecular and Clinical Pharmacology, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan. kiyoshimori2001@gmail.com.

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