Abstract 4138719: Effect of Recombinant Human Brain Natriuretic Peptide on Cardiac Surgery Associated Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Grafting

Backgrounds: Cardiac surgery associated acute kidney injury (CSA-AKI) is a prevalent and detrimental complication following cardiac surgery, with significant effects on both in-hospital and long-term morbidity and mortality. The effect on renal prognosis of recombinant human brain natriuretic peptide (rhBNP) for patients undergoing cardiac surgery remains unclear. Purpose: This study aims to evaluate the association between postoperative rhBNP and the risk of CSA-AKI following coronary artery bypass grafting (CABG). Methods: This retrospective cohort study included 16096 consecutive patients undergoing CABG between 2017 and 2022. The primary outcome was in-hospital postoperative AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcome was the amplitude of postoperative NT-proBNP reduction, defined as a difference value between the highest and last results during hospitalization. Multivariate Cox proportional hazards regression models and linear regression models were constructed to assess the association between perioperative statin and pre-defined outcomes. Results: A total of 9392 (58.3%) patients received postoperative rhBNP therapy, with a total of 1474 (9.2%) patients developing CSA-AKI. For the primary outcome, postoperative rhBNP was associated with a significantly increased risk of CSA-AKI (83.0% vs. 55.9%; adjusted Odds Ratio [OR], 3.615 [95% CI, 3.136-4.166]; p < 0.001). Noticeably, we found that postoperative rhBNP was also related to increased amplitude of postoperative NT-proBNP reduction, with an average of 3193.98 versus 1040.21 pg/mL (p for linear < 0.001). For the subgroup analysis, the association between postoperative rhBNP and reduced CSA-AKI risk was greater among patients with HFpEF (p for interaction = 0.087). Conclusions: Postoperative rhBNP therapy was associated with a significantly higher risk of CSA-AKI following CABG. Meanwhile, rhBNP contributed to NT-proBNP reduction postoperatively, with a more pronounced effect in patients with HFpEF.