Renin-angiotensin system control for chronic kidney disease patients undergoing coronary surgery

Abstract

Purpose: We investigated the effectiveness of active renin-angiotensin-aldosterone system (RAAS) control with human atrial natriuretic peptide (hANP) and an angiotensin II receptor blocker (ARB) in patients with chronic kidney disease (CKD) undergoing coronary artery bypass grafting (CABG). Methods: A total of 286 consecutive patients with CKD undergoing CABG were divided into three groups: Group C (n = 50) receiving placebo,the hANP group (n = 60) receiving hANP,and the active RAAS control therapy (ARC) group (n = 56) receiving hANP plus an ARB. Renal function,brain natriuretic peptide (BNP) and RAAS parameters were analyzed. Results: After 1 year,renal function parameters were better in the hANP and ARC groups compared with group C,and the dialysis rate was significantly lower (group C: 12%,hANP group: 1.7%,ARC group: 1.8%,p = 0.018) in the hANP and ARC groups. BNP levels were significantly lower in the hANP and ARC groups compared with group C (p = 0.001). There was also a significant difference of aldosterone among the groups (p = 0.023),as well as a significant difference between group C and the ARC group (p = 0.017). Conclusions: The present study showed that active RAAS control preserved renal function in patients with CKD undergoing CABG. The improved early postoperative outcome with RAAS control may lead to long-term inhibition of cardiovascular events.