Lack of association between worsening renal function and mortality in heart failure patients treated with nesiritide

Wayne L. Miller, Shaun Kurien, Karen T. Warfield, Christina M. Wood, Allan S Jaffe

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Nesiritide is approved for the treatment of decompensated heart failure. Because nesiritide may exacerbate renal dysfunction, it has been claimed that there may be a link between worsening renal function caused by nesiritide and increased mortality. Aims: We analyzed our inpatient experience with nesiritide to determine if changes in renal function were associated with worsened mortality. Methods and results: A retrospective study of 167 patients [65% male, median age 70 years, left ventricular ejection fraction (LVEF) 30%, glomerular filtration rate (GFR) 36 mL/min/1.73 m 2, serum creatinine (sCr)1.8 mg/dL] treated with standard dose nesiritide was undertaken for the period September 2001-March 2005. Mortality was 12.5% at 1 month and 51% at 24 months (median follow-up was 5.4 months [interquartile ranges (IQR) 1.3, 18.6]. Higher mortality was associated with lower pre-infusion GFR (hazard ratio for a 10 mL/min/1.72 m 2 decrease = 1.22, p = 0.004). Pre-to-post nesiritide changes in GFR (median 0.0, IQR-5.8, 8.4; p = 0.51) and creatinine (median 0.0, IQR - 0.3, 0.3; p = 0.91), however, were not significant and not detected to be associated with worsened mortality by Cox proportional hazards (p = 0.46 and p = 0.40, respectively). Conclusions: While we found that nesiritide infusion in decompensated heart failure patients worsened renal function (decrease in GFR) in 29% of patients, changes in renal function could not be related to an incremental worsening of mortality. Our findings do not support an association of worsening renal function and worsening mortality after nesiritide.

Original languageEnglish (US)
Pages (from-to)234-239
Number of pages6
JournalInternational Journal of Cardiology
Volume126
Issue number2
DOIs
StatePublished - May 23 2008

Fingerprint

Brain Natriuretic Peptide
Heart Failure
Kidney
Mortality
Glomerular Filtration Rate
Creatinine
Stroke Volume
Inpatients
Retrospective Studies
Serum

Keywords

  • Heart failure
  • Nesiritide
  • Outcomes
  • Renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lack of association between worsening renal function and mortality in heart failure patients treated with nesiritide. / Miller, Wayne L.; Kurien, Shaun; Warfield, Karen T.; Wood, Christina M.; Jaffe, Allan S.

In: International Journal of Cardiology, Vol. 126, No. 2, 23.05.2008, p. 234-239.

Research output: Contribution to journalArticle

Miller, Wayne L. ; Kurien, Shaun ; Warfield, Karen T. ; Wood, Christina M. ; Jaffe, Allan S. / Lack of association between worsening renal function and mortality in heart failure patients treated with nesiritide. In: International Journal of Cardiology. 2008 ; Vol. 126, No. 2. pp. 234-239.
@article{138f8ded43c942b3a383066655734c58,
title = "Lack of association between worsening renal function and mortality in heart failure patients treated with nesiritide",
abstract = "Background: Nesiritide is approved for the treatment of decompensated heart failure. Because nesiritide may exacerbate renal dysfunction, it has been claimed that there may be a link between worsening renal function caused by nesiritide and increased mortality. Aims: We analyzed our inpatient experience with nesiritide to determine if changes in renal function were associated with worsened mortality. Methods and results: A retrospective study of 167 patients [65{\%} male, median age 70 years, left ventricular ejection fraction (LVEF) 30{\%}, glomerular filtration rate (GFR) 36 mL/min/1.73 m 2, serum creatinine (sCr)1.8 mg/dL] treated with standard dose nesiritide was undertaken for the period September 2001-March 2005. Mortality was 12.5{\%} at 1 month and 51{\%} at 24 months (median follow-up was 5.4 months [interquartile ranges (IQR) 1.3, 18.6]. Higher mortality was associated with lower pre-infusion GFR (hazard ratio for a 10 mL/min/1.72 m 2 decrease = 1.22, p = 0.004). Pre-to-post nesiritide changes in GFR (median 0.0, IQR-5.8, 8.4; p = 0.51) and creatinine (median 0.0, IQR - 0.3, 0.3; p = 0.91), however, were not significant and not detected to be associated with worsened mortality by Cox proportional hazards (p = 0.46 and p = 0.40, respectively). Conclusions: While we found that nesiritide infusion in decompensated heart failure patients worsened renal function (decrease in GFR) in 29{\%} of patients, changes in renal function could not be related to an incremental worsening of mortality. Our findings do not support an association of worsening renal function and worsening mortality after nesiritide.",
keywords = "Heart failure, Nesiritide, Outcomes, Renal function",
author = "Miller, {Wayne L.} and Shaun Kurien and Warfield, {Karen T.} and Wood, {Christina M.} and Jaffe, {Allan S}",
year = "2008",
month = "5",
day = "23",
doi = "10.1016/j.ijcard.2007.03.133",
language = "English (US)",
volume = "126",
pages = "234--239",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "2",

}

TY - JOUR

T1 - Lack of association between worsening renal function and mortality in heart failure patients treated with nesiritide

AU - Miller, Wayne L.

AU - Kurien, Shaun

AU - Warfield, Karen T.

AU - Wood, Christina M.

AU - Jaffe, Allan S

PY - 2008/5/23

Y1 - 2008/5/23

N2 - Background: Nesiritide is approved for the treatment of decompensated heart failure. Because nesiritide may exacerbate renal dysfunction, it has been claimed that there may be a link between worsening renal function caused by nesiritide and increased mortality. Aims: We analyzed our inpatient experience with nesiritide to determine if changes in renal function were associated with worsened mortality. Methods and results: A retrospective study of 167 patients [65% male, median age 70 years, left ventricular ejection fraction (LVEF) 30%, glomerular filtration rate (GFR) 36 mL/min/1.73 m 2, serum creatinine (sCr)1.8 mg/dL] treated with standard dose nesiritide was undertaken for the period September 2001-March 2005. Mortality was 12.5% at 1 month and 51% at 24 months (median follow-up was 5.4 months [interquartile ranges (IQR) 1.3, 18.6]. Higher mortality was associated with lower pre-infusion GFR (hazard ratio for a 10 mL/min/1.72 m 2 decrease = 1.22, p = 0.004). Pre-to-post nesiritide changes in GFR (median 0.0, IQR-5.8, 8.4; p = 0.51) and creatinine (median 0.0, IQR - 0.3, 0.3; p = 0.91), however, were not significant and not detected to be associated with worsened mortality by Cox proportional hazards (p = 0.46 and p = 0.40, respectively). Conclusions: While we found that nesiritide infusion in decompensated heart failure patients worsened renal function (decrease in GFR) in 29% of patients, changes in renal function could not be related to an incremental worsening of mortality. Our findings do not support an association of worsening renal function and worsening mortality after nesiritide.

AB - Background: Nesiritide is approved for the treatment of decompensated heart failure. Because nesiritide may exacerbate renal dysfunction, it has been claimed that there may be a link between worsening renal function caused by nesiritide and increased mortality. Aims: We analyzed our inpatient experience with nesiritide to determine if changes in renal function were associated with worsened mortality. Methods and results: A retrospective study of 167 patients [65% male, median age 70 years, left ventricular ejection fraction (LVEF) 30%, glomerular filtration rate (GFR) 36 mL/min/1.73 m 2, serum creatinine (sCr)1.8 mg/dL] treated with standard dose nesiritide was undertaken for the period September 2001-March 2005. Mortality was 12.5% at 1 month and 51% at 24 months (median follow-up was 5.4 months [interquartile ranges (IQR) 1.3, 18.6]. Higher mortality was associated with lower pre-infusion GFR (hazard ratio for a 10 mL/min/1.72 m 2 decrease = 1.22, p = 0.004). Pre-to-post nesiritide changes in GFR (median 0.0, IQR-5.8, 8.4; p = 0.51) and creatinine (median 0.0, IQR - 0.3, 0.3; p = 0.91), however, were not significant and not detected to be associated with worsened mortality by Cox proportional hazards (p = 0.46 and p = 0.40, respectively). Conclusions: While we found that nesiritide infusion in decompensated heart failure patients worsened renal function (decrease in GFR) in 29% of patients, changes in renal function could not be related to an incremental worsening of mortality. Our findings do not support an association of worsening renal function and worsening mortality after nesiritide.

KW - Heart failure

KW - Nesiritide

KW - Outcomes

KW - Renal function

UR - http://www.scopus.com/inward/record.url?scp=42649089800&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=42649089800&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2007.03.133

DO - 10.1016/j.ijcard.2007.03.133

M3 - Article

C2 - 17482692

AN - SCOPUS:42649089800

VL - 126

SP - 234

EP - 239

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 2

ER -