The effects of nesiritide on renal function and diuretic responsiveness in acutely decompensated heart failure patients with renal dysfunction.
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 mug/kg bolus; 0.01 mug/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.


CONCLUSIONS
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.
Owan
Theophilus E
TE
Mayo Clinic College of Medicine, Division of Cardiovascular Diseases, Rochester, Minneosta 55905.
Chen
Horng H
HH
Frantz
Robert P
RP
Karon
Barry L
BL
Miller
Wayne L
WL
Rodeheffer
Richard J
RJ
Hodge
David O
DO
Burnett
John C
JC
Redfield
Margaret M
MM
D000368:Aged; D000465:Algorithms; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D006152:Cyclic GMP / Q000097:blood; D004231:Diuresis / Q000187:drug effects*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004727:Endothelium / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D045283:Natriuretic Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000503:physiopathology*; D013148:Spironolactone / Q000627:therapeutic use; D013318:Stroke Volume; D013997:Time Factors
D000451:Mineralocorticoid Receptor Antagonists; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D013148:Spironolactone; D003404:Creatinine; D006152:Cyclic GMP