B‐Natriuretic Peptide for the Prevention of Radiocontrast‐Induced Nephropathy

Abstract

AbstractBACKGROUND:The hypothesis of the study was that infusion of B‐natriuretic peptide (BNP), by increasing renal vasodilatation and glomerular filtration, would reduce the incidence of radiocontrast nephropathy (RCIN) after cardiac catheterization in patients with preexisting renal insufficiency.METHODS:The study was a single‐center, prospective, randomized, double‐blind, placebo‐controlled pilot study of 50 patients. Patients with a baseline serum creatinine (SCr) > 1.5 mg/dL not on dialysis undergoing elective cardiac catheterization with visipaque (nonionic, iso‐osmolal contrast) were enrolled. Patients were randomly assigned to receive intravenous BNP or placebo infusion. RCIN was defined as SCr increase ≥ 0.5 mg/dL at 48 hours post‐contrast administration.RESULTS:There were no significant differences in baseline characteristics between the 2 groups. The incidence of RCIN was 3.8% (1 of 26) in the BNP group versus 12.5% (3 of 24) in the placebo group (p = 0.340). None of the patients who developed RCIN required renal replacement therapy, and all their SCr values returned to baseline on posthospital follow‐up. On logistic regression only the baseline SCr was an independent predictor of RCIN.CONCLUSIONS:BNP infusion shows a nonsignificant trend of reduction in the incidence of RCIN in patients with chronic renal insufficiency undergoing elective cardiac catheterization. Further large‐scale trials are needed to determine the usefulness of BNP infusion to prevent RCIN.