B-natriuretic peptide for the prevention of radiocontrast-induced nephropathy

Abstract

BACKGROUND: 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.