Abstract: FR-PO123

Low-Dose Atrial Natriuretic Peptide for Preventing and Treating AKI: Systematic Review and Meta-Analysis

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Yamada, Hiroyuki, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • Doi, Kent, University of Tokyo, Tokyo, Japan
  • Tsukamoto, Tatsuo, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
  • Yamashita, Kazuto, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • Kiyomoto, Hideyasu, Tohoku University, Sendai, Japan
  • Yanagita, Motoko, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • Terada, Yoshio, Kochi Medical University, Kochi, Japan
  • Mori, Kiyoshi, Shizuoka General Hospital, Shizuoka, Japan
Background

Low-dose atrial natriuretic peptide (ANP) could theoretically bring about beneficial effect for acute kidney injury (AKI) as a pharmacological intervention. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing low-dose ANP with placebo or conventional therapy for the prevention or treatment of AKI.

Methods

Low dose of ANP was defined as 50 ng/kg/min or smaller according to KDIGO AKI Guideline 2012. EMBASE, PubMed and Cochrane CENTRAL databases were searched for RCTs comparing low-dose ANP with placebo or conventional therapy for patients with high risk of AKI or with AKI. Two reviewers independently collected data assessed outcomes. The primary outcome was hospital mortality. Secondary outcomes were requirement of renal replacement therapy (RRT), length of intensive care unit (ICU) stay and incidence of hypotension. The risk of bias was evaluated using Cochrane risk of bias tool. Trial sequential analysis was used for the main outcome of interest. The publication bias of the included studies was assessed by funnel plot. All the statistical analyses were performed using Review Manager Version 5.3 and TSA version 0.9 version software.

Results

A total of 18 RCTs (16 prevention, 2 treatment) fulfilled our inclusion criteria. Most of them had a high or unclear risk of bias in more than two domains. Low-dose ANP showed a significantly beneficial effect to reduce RRT both in the prevention trials (RR 0.20; 95%CI 0.07−0.59; p=0.003) and treatment trials (RR 0.43; 95%CI 0.20−0.93; p=0.03). Regarding RRT, however, TSA indicated that the number of patients included was below the information size required for a definitive conclusion. On the other hand, no significant difference was observed on hospital mortality, length of ICU stay and induction of hypotension. The shape of the funnel plots in each outcome did not show an obvious asymmetry.

Conclusion

These results indicated that low-dose ANP could be potentially effective for the prevention and treatment of AKI. However, the quality and sample sizes of these RCTs were not sufficient to demonstrate the effects of low-dose ANP. It showed the necessity for RCTs with high-quality and large sample size.