Effect of nesiritide infusion duration on renal function in acutely decompensated heart failure patients.
BACKGROUND
Nesiritide, a synthetic B-type natriuretic peptide, is used for the treatment of patients with acutely decompensated heart failure. Although nesiritide has been reported to worsen renal function, as reflected by significant elevations in serum creatinine (SCr), the impact of infusion duration on renal function has not been evaluated.


OBJECTIVE
To investigate the effect of nesiritide infusion duration (< 24 h vs > or = 24 h) on worsening renal function in patients with acutely decompensated heart failure.


METHODS
Medical records of hospitalized patients receiving nesiritide were retrospectively reviewed, and 84 consecutive charts of patients with acute decompensated heart failure and available renal function tests were identified for the study. SCr and blood urea nitrogen (BUN) were documented at baseline and during infusion. Worsening renal function was defined as an increase in SCr of 0.5 mg/dL or more or BUN 10 mg/dL or more from baseline.


RESULTS
Univariate analysis showed a significant association between nesiritide infusion duration of 24 hours or more (26.1% vs 2.6%; p = 0.003), high diuretic doses (61.5% vs 32.4%; p = 0.045), and baseline SCr (2.0 +/- 0.8 vs 1.5 +/- 0.7 mg/dL; p = 0.04) with increases in SCr of 0.5 mg/dL or more. However, only infusion duration of 24 hours or more was statistically significant on multivariate analysis, after adjusting for baseline SCr (OR 10.46; 95% CI 1.26 to 86.72; p = 0.03). Longer duration of infusion was also a consistent variable in both univariate and multivariate analysis when elevated BUN was evaluated (34.8 vs 2.6%; p < 0.001 and OR 19.73; 95% CI 2.47 to 157.46; p = 0.005, respectively).


CONCLUSIONS
Nesiritide infusion of 24 hours or more appears to be significantly associated with elevated markers of worsening renal function in patients with acutely decompensated heart failure compared with infusion of less than 24 hours; however, prospective studies are needed to corroborate this finding.
Chow
Sheryl L
SL
Western University of Health Sciences, Pomona, CA 91766, USA. SChow@westernu.edu
Peng
Jessica T
JT
Okamoto
Mark P
MP
Heywood
J Thomas
JT
D000368:Aged; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects*; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D045265:Natriuretic Peptides / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D012189:Retrospective Studies
D045265:Natriuretic Peptides; D020097:Natriuretic Peptide, Brain; D003404:Creatinine