The pathogenesis of recombinant human brain natriuretic peptide for prevention of further renal damage in patients with chronic kidney disease undergoing coronary angiography or nonemergent percutaneous coronary intervention

doi:10.3969/j.issn.10073205.2016.10.009

Abstract

Abstract: [
Abstract ] Objective Toinvestigatetheeffectofrecombinanthuman brainnatriuretic
peptide ( rhBNP ) forpreventionofcontrast-induced nephropathy (
CIN ) in unstableangina
patientswithmoderatechronickidneydisease ( CKD ) undergoingcoronaryangiography ( CAG ) or
non-emergentpercutaneouscoronaryintervention ( PCI ) .Methods Twohundredandninecases ofselectedpatients wererandomlydividedinto : Hydrationgroup ( 103cases ) whoreceived
intravenous0.9%sodiumchloridewith1.0mL ·
kg
-1 · h -1 inthepreoperativeandpostoperative
12h ; rhBNPgroup ( 106cases ) whoreceivedthelowdoserhBNP ( 0.005 μ g ·
kg
-1 · min -1 )
inthe
preoperative24h.CystatinC ( CysC ), serumcreatinine ( SCr ) andestimatedglomerularfiltration
rate ( eGFR ) levelswerecollectedbeforeprocedure , at24h , 48h , 1weekand1monthafter
procedure.And wedetectedtumornecrosisfactor ( TNF-α ) andaldosterone ( ALD ) inthe
preoperativeandpostoperative12h .TheprimaryoutcomewasCINincidence.Thesecondary
endpointwasthechangesintheCysC , SCr , eGFR , TNF-αandALDbeforeandafterprocedure.
Results TheincidenceofCINinpatientsonrhBNPgroupwas8. 5% , whichwassignificantly
lowerthanthoseonhydrationgroupof23.3% ( P <0.01 ), whetherperformingCAGorPCI ( all
P <0.05 ) .CysCofthetwogroupswaselevatedtopeakatpostoperative24h , andreturnedto
thepreoperativelevelsonemonthafteroperation.ButrhBNPgroupelevatedtoalesserextent
thanhydrationgroup.TheSCrandeGFRofthetwogroupsbegantoincreaseordecreaseat
postoperative24h , hydrationgroupachievedtomaximumchangeatpostoperative1week , and
returnedtothepreoperativelevelsonemonthafteroperation.rhBNPgroupachievedtomaximum
changeatpostoperative48h , andreturnedtothepreoperativelevelsoneweekafteroperation.
AndthevariationwidthofSCrandeGFRwassmaller.AfteroperationthelevelsofTNF-αand
ALD weresignificantlyhighercompared withbeforeoperation ( P <0.05 ), hydrationgroup
increasedmoresignificantly ( P <0.05 ) .Conclusion Exogenousadministrationoflowdoseof
rhBNPbeforeCAG ornon-emergentPCIhasaprotectiveeffectonrenalfunctionandcan
significantlydecreasetheincidenceofCIN , theeffectisbetterthanhydrationtreatment.rhBNP
canreducethedegreeofrenaldamageandshortenthetimeofrecoveryofrenalfunction.The
effectofpreventedCINofrhBNPmaybethroughthemechanismofinhibitingtheinflammatory
responseandtherenin-angiotensin-aldosteronesystem.

Key words: nephrosis , coronaryangiography , natriureticpeptide

WANG Hongchao1， HE Fang2， LIU Jinming1*， XIE Yanan1， LI Fang1， WANG Wensu3. The pathogenesis of recombinant human brain natriuretic peptide for prevention of further renal damage in patients with chronic kidney disease undergoing coronary angiography or nonemergent percutaneous coronary intervention[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2016.10.009.

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The pathogenesis of recombinant human brain natriuretic peptide for prevention of further renal damage in patients with chronic kidney disease undergoing coronary angiography or nonemergent percutaneous coronary intervention

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