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


OBJECTIVE
We analyzed our inpatient experience with nesiritide to determine if changes in renal function were associated with worsened mortality.


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.
Miller
Wayne L
WL
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States. miller.wayne@mayo.edu
Kurien
Shaun
S
Warfield
Karen T
KT
Wood
Christina M
CM
Jaffe
Allan S
AS
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
D020097:Natriuretic Peptide, Brain