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AN ANALOG OF ATRIAL NATRIURETIC PEPTIDE FOR ATN.

The treatment of acute tubular necrosis of the kidney (ATN) has remained largely supportive for many years. Atrial natriuretic peptide is known to increase the glomerular filtration rate, and thus is a candidate for treatment of ATN. This multicenter, randomized study from North America examined whether anaritide, a synthetic form of atrial natriuretic peptide, improved outcomes among 504 patients with ATN.

The patients received a 24-hour intravenous infusion of either anaritide or placebo, administered when the mean serum creatinine was about 4.5 mg/dl and rising. The overall proportion of patients surviving 21 days without needing dialysis was similar in the two groups (43 percent with anaritide and 47 percent with placebo). However, in a subgroup with oliguria (i.e., less than 400 ml urine output per day), the dialysis-free survival rate was significantly better with anaritide than with placebo (27 vs. 8 percent). In contrast, among patients without oliguria, dialysis-free survival was significantly worse with anaritide (48 vs. 59 percent).

Comment: Anaritide may benefit oliguric patients with ATN. The poor result in the non-oliguric subgroup suggests that oliguric and non-oliguric patients have different intrarenal hemodynamic responses to this drug.

— AS Brett

Published in Journal Watch General Medicine April 1, 1997

Citation(s):

Allgren RL et al. Anaritide in acute tubular necrosis. N Engl J Med 1997 Mar 20 336 828-834.

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