***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim was to study the renal and hormonal effects of intravenous 99 - 126 atrial natriuretic factor ( ANF ) infusion in a mixed group of patients who had moderate to severe chronic renal failure ( CRF ) and who were not treated with dialysis . The peak mean plasma level of ANF  achieved during the experiment was at the upper limit of an absolute range of basal values previously recorded in a larger group of patients with similar degrees of renal impairment . A significant tissue effect was confirmed by rises in plasma and urinary cyclic guanosine monophosphate , the ' second-messenger ' of ANF .  ANF infusion increased sodium excretion rate by a mean of 68 % compared with a fall of 40 % in a placebo group , and significant increases in urinary albumin excretion occurred during the peptide infusion . Thus , the high levels of plasma ANF found in CRF may have a role in the maintenance of sodium balance . In addition , the proteinuric effect may be detrimental to long-term renal function 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 left ventricular ( LV ) function were examined . The hANP group showed significantly lower renin activity and lower levels of angiotensin-II and aldosterone during the early postoperative period , compared with the non-hANP group . The incidence of postoperative ventricular arrhythmia and the postoperative peak level of creatine kinase-MB were significantly lower in the hANP group . BNP at 1 month after surgery and measures of LV function were also significantly lower in the hANP group . CONCLUSIONS Low-dose continuous infusion of hANP during cardiac surgery not only had a compensatory effect for the imperfections of CPB during the early postoperative period but also an inhibitory effect on postoperative LV remodeling and a reduction in ischemia/reperfusion injury . hANP should be part of the postoperative care for cardiac surgery Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES Continuous low-dose infusion of human atrial natriuretic peptide ( hANP ) in patients undergoing cardiac surgery on cardiopulmonary bypass ( CPB )  inhibits the renin-angiotensin-aldosterone system and compensates for the adverse effects of CPB . BACKGROUND We examined the influence of hANP infusion on cardiac and renal function in patients with left ventricular dysfunction undergoing coronary artery bypass grafting ( CABG ) . METHODS The subjects were 133 patients who underwent CABG and had a pre-operative ejection fraction < or = 35 % . They were r and omized to receive 0.02 microg/kg/min of hANP from the initiation of CPB ( hANP group ) or placebo ( saline ) infusion . RESULTS Early post-operative mortality did not show a significant difference between the 2 groups , but perioperative complications were significantly less frequent in the hANP group ( p = 0.015 ) . Long-term all-cause mortality showed no difference , but the cardiac death-free rate at 5 or 8 years post-operatively was 98.5 % in the hANP group and 85.5 % in the placebo group ( p = 0.0285 ) . Post-operative ejection fraction was significantly larger and the post-operative brain natriuretic peptide level was significantly lower in the hANP group . Serum creatinine was significantly lower in the hANP group than the placebo group at 1 month , 6 months , and 1 year post-operatively , whereas the estimated glomerular filtration rate was significantly higher in the hANP group at these times . CONCLUSIONS In patients with left ventricular dysfunction undergoing CABG , hANP showed renal- and cardio-protective effects and reduced post-operative complications . It also improved the long-term prognosis . We suggest that hANP should be considered as part of perioperative management of patients with cardiac dysfunction undergoing cardiac surgery . ( NU-HIT trial for LVD ; UMIN000001652 ) BACKGROUND We evaluated the effects of human atrial natriuretic peptide ( hANP ) during cardiopulmonary bypass ( CPB ) . METHODS Forty patients undergoing coronary artery bypass grafting were investigated . A group of patients given hANP for 24 hours from the start of CPB ( hANP group ) was compared with a non-hANP group . Parameters examined were hemodynamics , urine volume , dosage of furosemide , respiratory index , pleural effusion , ANP , cyclic guanosine monophosphate , renin activity ( renin ) , angiotensin-II , aldosterone , and glomerular filtration rate . RESULTS Central venous pressure , systemic vascular resistance index , and pulmonary vascular resistance index were significantly lower in the hANP group than in the non-hANP group . The hANP group showed significantly higher levels of ANP , cyclic guanosine monophosphate , glomerular filtration rate , and respiratory index , and significantly lower levels of renin , angiotensin-II , aldosterone , and pleural effusion , as compared with the non-hANP group . The dosage of furosemide was significantly lower and the urine volume was significantly larger in the hANP group . CONCLUSIONS hANP can satisfactorily compensate for the shortcomings of CPB by decreasing the peripheral vascular resistance , suppressing the renin-angiotensin-aldosterone system , and exerting a strong diuretic effect Background / Aims : Although contrast-induced acute kidney injury ( CIAKI ) is a major complication associated with angiography , the prophylaxis is not well established . Use of a low dose of carperitide for preventing CIAKI remains controversial . We examined the protective effect of carperitide on CIAKI after coronary angiography with a small contrast volume in chronic kidney disease ( CKD ) patients with coronary artery disease . Methods : We r and omly assigned 112 consecutive patients to a carperitide or a control group . The contrast volume was kept under 150 ml . The primary endpoint was the incidence of CIAKI defined by a serum creatinine of ≥25 % or a serum creatinine of ≥0.5 mg/dl from baseline within 48 h. The secondary endpoint was a change in renal function at 1 week after the procedure . Results : The baseline characteristics and contrast volumes ( carperitide group : 67.4 ± 38.2 ml vs. control group : 64.8 ± 20.5 ml , p = 0.661 ) were comparable in the two groups . The incidence of CIAKI was similar in the two groups ( carperitide group : 8.5 % vs. control group : 5.7 % , p = 0.564 ) . A multivariate analysis revealed that a hypotension ≥20 mm Hg was a significant predictor of developing CIAKI in the carperitide group ( p = 0.015 ) . The incidence of CIAKI in the carperitide group without hypotension was rare , but not significantly different ( carperitide group : 2.4 % vs. control group : 5.7 % , p = 0.432 ) . Conclusions : This study indicated that the use of a small contrast volume suppressed the incidence of CIAKI and that carperitide had no prophylactic effect against CIAKI . Our results also revealed the impact of hypotension on the development of CIAKI in the carperitide group Atrial natriuretic factor ( ANF ) ameliorates renal damage in animal models of acute ischemic renal failure . Consequently , ANF could blunt acute tubular necrosis related to ischemia that occurs frequently in cadaveric renal transplants . Ten pairs of cadaveric kidneys were transplanted into 20 recipients . Paired recipients received either alpha-human ANF ( hANF ) or vehicle alone in a prospect i ve , double-blind protocol . Upon revascularization of the allograft , either hANF or vehicle was administered intravenously as a 50-micrograms bolus , followed by a 4-h infusion ( 0.1 microgram/kg/min ) . Glomerular filtration rate ( [125I]iothalamate clearance ) was measured between 4 and 7 days posttransplant and again between 14 and 21 days posttransplant . Serum creatinine was measured daily when patients were in the hospital , then twice weekly as patients were examined in the outpatient clinic . Between the groups , there was no significant difference in age of the recipients or donors , cold ischemia time , or histocompatibility leukocyte antigen match . Infusion of hANF had no adverse effects . When subjects receiving hANF were compared with those treated with vehicle alone , there were no significant differences in serum creatinine or glomerular filtration rate . Three hANF and four vehicle recipients required dialysis postoperatively . At 1 month posttransplant , 19 of 20 patients had functioning allografts ; an allograft from one hANF recipient never functioned . It was concluded that hANF , when given by the protocol of this study , had no beneficial effect on the outcome of cadaveric renal transplantation in humans OBJECTIVES This study was design ed to examine the protective effects of atrial natriuretic peptide ( ANP ) on  contrast-induced nephropathy ( CIN ) after coronary angiography .  BACKGROUND Contrast-induced nephropathy is a common complication after angiography . Some studies have shown that ANP has renal protective effects , but the beneficial effects for CIN prevention remain to be clearly shown . METHODS In a prospect i ve , controlled , r and omized trial in 254 consecutive patients with serum creatinine concentrations of > or = 1.3 mg/dl , patients received  either ANP ( 0.042 microg/kg/min ; ANP group , n = 126 ) or Ringer solution alone ( control group , n = 128 ) . Treatment of either type was initiated 4 to 6 h before angiography and continued for 48 h. RESULTS There were no significant differences in age , sex , diabetes mellitus , or baseline serum creatinine level between the 2 groups . The prevalence of CIN , defined as a 25 % increase in creatinine or an increase in creatinine of > or = 0.5 mg/dl from baseline within 48 h , was significantly lower in the ANP group than in the control group ( 3.2 % vs. 11.7 % , respectively ; p = 0.015 ) . Multivariate analysis revealed that the use of > 155 ml of contrast medium ( odds ratio : 6.89 ; p < 0.001 ) and ANP treatment ( odds ratio : 0.24 ; p = 0.016 ) were significant predictors of developing CIN . The incidence of an increase in creatinine of > or = 25 % or of > or = 0.5 mg/dl from baseline at 1 month was also significantly lower in the ANP group than in the control group ( p = 0.006 ) . CONCLUSIONS In addition to hydration , ANP administration is effective in the prevention of CIN  in patients with chronic renal failure , and the effect was maintained for 1 month This study was performed to investigate the effects of atrial natriuretic peptide ( ANP ) and mannitol on renal blood flow ( RBF ) and radiocontrast-induced nephropathy ( RCIN ) in human subjects with chronic renal failure . ANP preserves glomerular filtration rate or RBF ( or both ) in severe animal models of acute renal failure . Radiocontrast is known to substantially decrease RBF and can induce acute renal failure .  Twenty consecutive patients with chronic renal failure ( 60 % with diabetes ) were r and omized in a prospect i ve , double-blind fashion to receive either ANP ( 50 micrograms bolus , then 1 microgram/min infusion ) or mannitol ( 15 % at 100 ml/hr ) for 2 hours before and during cardiac catheterization with diatrizoate . Baseline serum creatinine level ( ANP 2.4 + /- 0.7 mg/dl , mannitol 2.5 + /- 0.8 mg/dl ) , medications , and quantity of radiocontrast were similar in both groups . Direct measurements of RBF were made with thermodilution catheters placed in the left renal vein . RBF rose significantly ( p less than 0.05 ) , to 198 % of baseline at 15 minutes and 166 % of baseline at 65 minutes in the group receiving ANP and remained stable in the group receiving mannitol .  ANP levels rose significantly from baseline at 5 , 15 , 65 and 120 minutes in both groups ( p less than 0.05 
    Output:
    
Among secondary outcomes , in some cases , low-dose ANP was associated with a reduction in ICU and in-hospital stay .
The risk-of-bias assessment and TSA results indicated that the sample sizes and qualities of the RCTs were insufficient to conclude the efficacy of low-dose ANP .
Conclusion Low-dose ANP might be effective in preventing or treating AKI .
However , the evidence accumulated so far is not strong enough to demonstrate ANP ’s beneficial effects .