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Could atrial natriuretic peptide be a useful drug therapy for high-risk patients after cardiac surgery?

^a Department of Pediatrics, Children's Hospital of New Jersey, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ 07112, USA
^b Department of Pediatrics, Children's Hospital at Monmouth Medical Center, Long Branch, NJ 07740, USA
^c Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Tel.: +1-732-582-6339.

E-mail address: jagdish.ambwani{at}gmail.com (J. Ambwani).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether atrial natriuretic peptide (ANP) or brain natriuretic peptide (BNP) could be a useful alternative diuretic for patients post cardiac surgery. Altogether more than 250 papers were found using the reported search, of which eight RCTs represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the RCTs consistently showed a diuretic effect with increased creatinine clearance, and increased urine volume and reduced usage of conventional diuretics. Lower urea and creatinine levels were also found postoperatively and also reduced decreases in glomerular filtration rate compared to placebo, both in studies of patients with preoperatively normal renal function and those who had impaired function. In addition, two studies found a reduction in the incidence of AF, and renin/aldosterone levels were lower. The NAPA trial of 272 CABG patients with LV dysfunction was the only study to show a shorter ICU stay and reduced early mortality with nesiritide compared to placebo.

Key Words: Brain natriuretic peptide; Atrial natriuretic factor; Renal function; Thoracic surgery; Coronary artery bypass