EFFECTS OF ATRIAL-NATRIURETIC-PEPTIDE IN CLINICAL ACUTE-RENAL-FAILURE

Fifty-three consenting patients meeting clinical and urine composition criteria for established intrinsic ARF were assigned to two treatment groups. Group I patients were treated with human atrial natriuretic p eptide (ANP) with or without diuretics. Groups II: patients were treat ed with or without diuretics and with no ANP. Age, sex, etiology of AR F, entry serum creatinines (S-Cr) (Group I, 5.3 +/- 1.8; Group II, 5.1 +/-, 2.1 mg/dl) and creatinine clearances (C-Cr) (Group I, 9.9 +/- 2. 1; Group II, 9.2 +/- 2.1 ml/min) were similar. Thirty patients receive d ANP [0.20 mu g/kg/min i.v. x 24 hr (N = 20) or 0.08 mu g/kg/min i.a. x 8 hr (N = 10)] and furosemide, 0.5 mg/kg/hr x 24 hr or mannitol, 12 .5 g every six hours x 4, or no diuretic; 23 Group II patients receive d diuretics as above or no diuretic in a similar distribution to Group I. C-Cr (verified with simultaneous inulin clearances x 12, r = 0.93, P < 0.001) increased significantly by eight hours of ANP treatment to 17.1 +/- 3.2 ml/min and by 24 hours after discontinuing ANP to 21.0 /- 4.4 ml/min (both P < 0.05). There was no corresponding increase in C-Cr in Group II. Dialysis was required in 23% of Group I and in 52% o f Group II patients (different at P < 0.05). Mortality rates of 17% fo r Group I and 35% for Group II were not significantly different (P = 0 .11). It is concluded that parenteral ANP increases C-Cr and reduces n eed for dialysis in patients with established intrinsic ARF.