Effects of Continuous Venovenous Hemofiltration on the Pharmacology of Carperitide, a Recombinant Human Atrial Natriuretic Peptide

Abstract

Background: Natriuretic peptides exert vasodilatory, natriuretic, and diuretic effects and inhibit renin and aldosterone secretion. Carperitide, a recombinant α-human atrial natriuretic peptide (hANP), is used for the treatment of cardiac failure. Patients with renal failure often require renal replacement therapy, and little is known about the pharmacokinetics of carperitide when used for renal replacement therapy. Methods and Results: Eleven patients who received continuous carperitide infusion and needed continuous venovenous hemofiltration (CVVHF) for acute renal failure were observed. The plasma hANP concentration was noted and the hANP clearance during CVVHF was calculated. The results indicated that infused hANP was removed by CVVHF. Although the clearance of hANP by CVVHF was relatively lower than the expected whole body clearance, CVVHF slightly reduced plasma hANP and cyclic guanosine monophosphate concentrations and increased arterial pressure. Conclusions: CVVHF affects the pharmacology of infused hANP in critically ill patients. Some caution with respect to blood pressure may be necessary when carrying out CVVHF for critically ill patients receiving continuous infusion of natriuretic peptides.  (Circ J 2010; 74: 1888 - 1894)