The Effects of Nesiritide on Renal Function and Diuretic Responsiveness in Acutely Decompensated Heart Failure Patients With Renal Dysfunction

Theophilus E. Owan, Horng H. Chen, Robert P. Frantz, Barry L. Karon, Wayne L. Miller, Richard J. Rodeheffer, David O. Hodge, John C. Burnett, Margaret M. Redfield

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Background: Strategies to preserve renal function and enhance diuretic responsiveness during therapy for heart failure (HF) are needed. We hypothesized that brain natriuretic peptide (nesiritide) added to standard HF therapy would preserve renal function and enhance diuretic responsiveness. Methods: Patients with HF with underlying renal dysfunction who were admitted with volume overload were randomized to standard therapy with nesiritide (2 μg/kg bolus; 0.01 μg/kg/min for 48 hours) or without nesiritide. Patients requiring intravenous vasodilator or inotropic therapy for rapid symptom relief were ineligible. In all patients, diuretics were administered according to a standardized dosing algorithm. Results: Patients (n = 72) had a mean creatinine level of 1.75 ± 0.59 mg/dL. Patients receiving nesiritide had a lesser increase in creatinine (P = .048) and blood urea nitrogen (P = .02), but a greater reduction in blood pressure (P < .01). Nesiritide did not enhance diuretic responsiveness (P = .57) but increased 3′5′ cyclic guanosine monophosphate and decreased endothelin more (P < .05 for both). There were no differences in the change in atrial natriuretic peptide, N-terminal pro-brain natriuretic peptide, plasma renin activity, angiotensin II, and aldosterone between groups. Conclusion: When used as adjuvant "renal protective" therapy in patients with HF with renal dysfunction, the recommended dose of nesiritide reduced blood pressure, did not seem to worsen renal function, and suppressed endothelin but did not enhance diuretic responsiveness or prevent activation of the renin-angiotensin-aldosterone system.

Original languageEnglish (US)
Pages (from-to)267-275
Number of pages9
JournalJournal of Cardiac Failure
Volume14
Issue number4
DOIs
StatePublished - May 1 2008

Keywords

  • Natriuretic peptides
  • heart failure
  • renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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