Therapeutic Atrial Natriuretic Peptide infusion in Acute Kidney Injury

Abstract

Background Acute kidney injury (AKI) is a common complication after Cardio Pulmonary Bypass (CPB) Surgery in the pediatric population. Diuretics are used worldwide to treat this condition. Human Atrial Natriuretic Peptide (hANP) is a diuretic that has been used to treat acute kidney injury at Queen Silvia Children’s Hospital (DSBUS) for a decade. Despite this, no previous studies have been done on the effects of hANP among the pediatric AKI patients. Aim The aim is to evaluate the effects of hANP in the pediatric AKI population, with ambition to identify whether hANP treatment is associated with improved outcomes or not. Methods This is a retrospective cohort study on pediatric patients undergoing CPB surgery at DSBUS from January 1st 2010 through December 31st 2013. Two study groups (hANP and no-­‐hANP) were used. The data was extracted from the patients’ journals. Odds Ratio (OR) to assess the risk for dialysis was calculated using binary logistic regression. Non-­‐parametric tests were used to calculate differences between median values regarding Length of Stay in the Pediatric Intensive Care Unit (PICU LOS), CPB duration and time to dialysis initiation. Results A total of 75 patients were included (hANP, n=45, no-­‐hANP, n=30). No significant differences could be seen between the groups regarding CPB duration, incidence of dialysis or time to dialysis. However, the median PICU LOS were 3 days longer in the hANP group (7 days vs. 4 days, p=0.043) and for every ten minutes on the CPB machine, a 13 % increased risk for dialysis-­‐dependent AKI (p=0.017) was seen, regardless of hANP administration. Conclusions Longer time in CPB surgery is associated with an increased risk for dialysis-­‐dependent AKI. Because of the limited options for selection of population, the risk of selection bias is high. Hence, any conclusions based on this study should be resulting in an understanding that further studies are needed on this topic.