***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: OBJECTIVES We aim ed to evaluate the renoprotective role of renal-dose dopamine on cardiac surgical patients at high risk of postoperative renal dysfunction . The latter included older patients or those with pre-existing renal disease , elevated preoperative serum creatinine ( Cr ) , poor ventricular function , hypertension , diabetes mellitus and unstable angina requiring intravenous therapy . METHODS Fifty patients undergoing cardiopulmonary bypass ( CPB ) who fulfilled the entry criteria were prospect ively r and omized into two groups : Group 1 received a ' renal-dose ' ( 3 microg kg(-1 ) min(-1 ) ) dopamine infusion starting at anaesthetic induction for 48 h whilst saline infusion acted as placebo in Group 2 . The anaesthetic and CPB regimes were st and ardized . Urinary excretion of retinol binding protein ( RBP ) indexed to Cr , an accurate and sensitive marker of early renal tubular damage , was assessed daily for 6 days . Additional outcome measures included daily fluid balance , blood urea and serum Cr . Statistical comparisons were made using ANOVA and Mann-Whitney U-test . RESULTS No significant difference was found between the groups in their age , gender , preoperative NYHA class , ejection fraction , baseline serum Cr and duration of CPB and aortic cross-clamping . Renal replacement therapy was not required in any instance . Both groups demonstrated a similar and significant rise in urinary RBP throughout the study period . Dopamine-treated patients achieved more negative average fluid balance than those on placebo ( 5 vs. 229 ml , P<0.05 ) . CONCLUSIONS Renal-dose dopamine therapy failed to offer additional renoprotection to patients considered at increased risk of renal dysfunction after CPB Mannitol is often added to the cardiopulmonary bypass pump prime to reduce the incidence of renal dysfunction , but studies so far have been inconclusive . Urinary excretion of microalbumin and retinol binding protein are more sensitive than routine biochemical tests of renal function after cardiac surgery . We performed a double‐blind , r and omised , controlled trial in cardiac surgical patients with pre‐operative plasma creatinine < 130 μmol.l−1 . Twenty patients received 0.5 g.kg−1 of mannitol in the pump prime , whereas 20 control patients received an equivalent volume of Hartmann ’s solution .  Blood and urine sample s were taken on the day before surgery and daily for 5 days postoperatively for measurement of plasma urea and creatinine , urinary creatinine , retinol binding protein and microalbumin . We found no differences between the mannitol and control patients for any measured variable , and conclude that mannitol has little impact on renal function in patients with normal pre‐operative plasma creatinine concentrations OBJECTIVES Natriuretic peptides have been shown to improve renal blood flow and stimulate natriuresis . In a recent retrospective trial , we documented that prophylactic use of nesiritide was associated with a 66 % reduction in the odds for dialysis or in-hospital mortality at 21 days in patients undergoing high-risk cardiac surgery ; therefore , we design ed a prospect i ve trial . METHODS This prospect i ve , r and omized , clinical trial included 94 patients undergoing high-risk cardiac surgery comparing a 5-day course of continuous nesiritide ( at a dose of 0.01 microg x kg(-1 ) x min(-1 ) started before surgery ) versus placebo . The primary end point was dialysis and /or all-cause mortality within 21 days ; secondary end points were incidence of acute kidney injury , renal function , and length of stay . RESULTS Nesiritide did not reduce the primary end point of incidence of dialysis and /or all-cause mortality through day 21 ( 6.6 % vs 6.1 % ; P = .914 ) . Fewer patients receiving nesiritide had acute kidney injury ( defined as an absolute increase in serum creatinine > or = 0.3 mg/dL from baseline or a percentage increase in serum creatinine > or = 50 % from baseline within 48 hours ) compared with controls ( 2.2 % vs 22.4 % ; P = .004 ) , and mean serum creatinine was lower in the immediate postoperative period in the nesiritide group ( 1.18 + /- 0.41 mg/dL vs 1.45 + /- 0.74 mg/dL ; P = .028 ) . However , no difference in length of stay was noted ( nesiritide 20.73 + /- 3.05 days vs control 21.26 + /- 4.03 days ; P = .917 ) . CONCLUSIONS These results do not demonstrate a benefit for prophylactic use of nesiritide on the incidence of dialysis and /or death in patients undergoing high-risk cardiac surgery . Although nesiritide may provide some renal protection in the immediate postoperative period , no effect on length of stay was observed Thirty-six patients with preoperative renal dysfunction were studied to evaluate the effects of dopamine ( D ) and dopamine-nitroprusside ( DN ) on renal function during cardiopulmonary bypass ( CPB ) . No differences from the control group ( C ) were found in creatinine clearance , fractional sodium excretion , osmolarity and free-water clearance . Sodium output/intake ratio during CPB was higher in group D than in groups C and DN ( P less than 0.05 ) ; water output/intake ratio was higher in group D than in group C ( P less than 0.05 ) . Urine lysozime levels and alpha-glycosidase/creatinine ratios increased similarly in the three groups , suggesting ischemic tubular cell damage . No patients showed acute postoperative renal failure or a worsening of their renal dysfunction . The data suggest an increased water and sodium excretion during CPB with a dopamine infusion , possibly result ing from a renal vasodilator effect that was abolished by simultaneous nitroprusside administration We assessed the influence of the prophylactic use of a combination of the IV beta-adrenergic blocker , esmolol , and the phosphodiesterase III inhibitor , enoximone , on postbypass hemodynamic status , inflammation , and endothelial and organ function in a prospect i ve , r and omized , placebo-controlled study in 42 patients aged > 65 yr undergoing aortocoronary bypass grafting . In 21 patients , esmolol ( aim : heart rate < 70 bpm ) plus enoximone ( initial bolus of 0.5 mg/kg followed by a continuous infusion of 2.5 microg x kg(-1 ) x min(-1 ) ) was started after induction of anesthesia and continued until the morning of the first postoperative day ; another 21 patients received saline solution as placebo .  Hemodynamics , splanchnic perfusion ( gastric-arterial CO(2 ) gap ) , liver function ( glutathione transferase-alpha plasma levels ) , renal function ( creatinine clearance , urine concentrations of N-acetyl-beta-D-glucosaminidase ) , myocardial ischemia ( creatine-kinase MB and troponin T plasma levels ) , inflammation ( elastase , interleukin-6 and -8 plasma levels ) , and endothelial integrity ( adhesion molecules plasma levels ) were assessed at baseline , before and after cardiopulmonary bypass ( CPB ) , and in the intensive care unit until the first postoperative day . Catecholamine requirements were significantly less in the treated than in the nontreated patients . Heart rate was significantly slower , cardiac index was higher , and gastric-arterial CO(2 ) gap was significantly lower in the treatment group . Troponin T , beta-N-acetyl-beta-D-glucosaminidase , glutathione transferase-alpha , and soluble adhesion molecules increased significantly in the untreated control , but remained almost normal in the esmolol+enoximone patients . Inflammatory responses ( elastase/interleukins ) were attenuated by esmolol+enoximone . We conclude that , in comparison to an untreated control , the prophylactic use of a combination of esmolol and enoximone in elderly patients undergoing cardiac surgery with cardiopulmonary bypass result ed in overall beneficial effects on postbypass hemodynamic status , organ function , inflammatory response , and endothelial integrity Impairment of renal and splanchnic perfusion during and after cardiopulmonary bypass may be responsible for acute renal failure and endotoxin‐mediated systemic inflammation , respectively . We hypothesised that fenoldopam , a selective dopamine receptor agonist , would preserve renal function after cardiopulmonary bypass through its selective renal vasodilatory and natriuretic effects , and increase gastrointestinal mucosal perfusion by selective splanchnic vasodilation . We examined the effects of fenoldopam on haemodynamic parameters , creatinine clearance , fractional excretion of sodium , urine output , free water clearance and gastric mucosal pH in 31 patients undergoing elective coronary revascularisation . Patients were r and omly assigned to receive continuous infusions of fenoldopam 0.1 µg.kg−1.min−1 ( n = 16 ) or placebo ( n = 15 ) . Renal parameters were measured : during a 24‐h period before hospital admission , during cardiopulmonary bypass , from completion of cardiopulmonary bypass until 4 h later , from 4 to 8 h after cardiopulmonary bypass , and from 8 to 14 h after cardiopulmonary bypass . Gastric intramucosal pH was measured using a gastric tonometer before , during and after cardiopulmonary bypass . In the placebo group , but not the fenoldopam group , mean ( SD ) creatinine clearance decreased after separation from cardiopulmonary bypass , from 107 ( 36 ) to 71 ( 22 ) ml.min−1 ( p < 0.01 ) and from 107 ( 36 ) to 79 ( 26 ) ml.min−1 ( p < 0.01 ) for the 0–4 h and 4–8 h intervals after cardiopulmonary bypass , respectively . Changes in intramucosal pH were similar in both groups . The findings are consistent with the hypothesis that fenoldopam possesses a renoprotective effect in patients undergoing cardiopulmonary bypass OBJECTIVES The purpose of this study was to determine the role nesiritide might play in patients with left ventricular dysfunction undergoing coronary artery bypass grafting ( CABG ) using cardiopulmonary bypass ( CPB ) .  BACKGROUND Given the hemodynamic , neurohormonal , and renal effects of natriuretic peptides , nesiritide might be useful in the management of patients undergoing cardiac surgery . METHODS This prospect i ve , double-blind , exploratory evaluation r and omly assigned patients with ejection fraction < /=40 % who were undergoing CABG with anticipated use of CPB to receive either nesiritide or placebo  , in addition to usual care , for 24 to 96 h after induction of anesthesia . Postoperative renal function , hemodynamics , and drug use ( primary end points ) were assessed in patients who underwent CABG using CPB ;  mortality and safety ( secondary end points ) were assessed in all patients who received the study drug . RESULTS Of 303 r and omized patients , 279 received the study drug and 272 underwent CABG using CPB .  Compared with placebo , nesiritide was associated with a significantly attenuated peak increase in serum creatinine ( 0.15 + /- 0.29 mg/dl vs. 0.34 + /- 0.48 mg/dl ; p < 0.001 ) and a smaller fall in glomerular filtration rate ( -10.8 + /- 19.3 ml/min/1.73 m(2 ) vs. -17.2 + /- 21.9 ml/min/1.73 m(2 ) ; p = 0.001 ) during hospital stay or by study day 14 , and a greater urine output ( 2,926 + /- 1,179 ml vs. 2,350 + /- 1,066 ml ; p < 0.001 ) during the initial 24 h after surgery . In addition , nesiritide-treated patients had a shorter hospital stay ( p = 0.043 ) and lower 180-day mortality ( p = 0.046 ) . CONCLUSIONS Nesiritide in the setting of CABG with CPB is associated with improved postoperative renal function and possibly enhanced survival . ( The NAPA Trial ; ; ) BACKGROUND The aim of the present study was to evaluate the efficacy of alpha-human atrial natriuretic peptide ( hANP ) in cardiac surgery under cardiopulmonary bypass ( CPB ) .  METHODS AND RESULTS A prospect i ve r and omized study was conducted with 150 patients who underwent scheduled coronary artery bypass grafting  to compare a group of patients receiving 0.02 microg x kg(-1 ) x min(-1 ) of hANP from the initiation of CPB with a group not receiving hANP .  Hemodynamics , levels of atrial and brain natriuretic peptides ( BNP ) , angiotensin-II and aldosterone , renin activity , and 
    Output:
    
No pharmacological intervention significantly reduced mortality .
Fenoldopam , ANP and BNP show evidence of renoprotection .