Prophylactic nesiritide does not prevent dialysis or all-cause mortality in patients undergoing high-risk cardiac surgery.
OBJECTIVE
Natriuretic peptides have been shown to improve renal blood flow and stimulate natriuresis. In a recent retrospective trial, we documented that prophylactic use of nesiritide was associated with a 66% reduction in the odds for dialysis or in-hospital mortality at 21 days in patients undergoing high-risk cardiac surgery; therefore, we designed a prospective trial.


METHODS
This prospective, randomized, clinical trial included 94 patients undergoing high-risk cardiac surgery comparing a 5-day course of continuous nesiritide (at a dose of 0.01 microg x kg(-1) x min(-1) started before surgery) versus placebo. The primary end point was dialysis and/or all-cause mortality within 21 days; secondary end points were incidence of acute kidney injury, renal function, and length of stay.


RESULTS
Nesiritide did not reduce the primary end point of incidence of dialysis and/or all-cause mortality through day 21 (6.6% vs 6.1%; P = .914). Fewer patients receiving nesiritide had acute kidney injury (defined as an absolute increase in serum creatinine > or = 0.3 mg/dL from baseline or a percentage increase in serum creatinine > or = 50% from baseline within 48 hours) compared with controls (2.2% vs 22.4%; P = .004), and mean serum creatinine was lower in the immediate postoperative period in the nesiritide group (1.18 +/- 0.41 mg/dL vs 1.45 +/- 0.74 mg/dL; P = .028). However, no difference in length of stay was noted (nesiritide 20.73 +/- 3.05 days vs control 21.26 +/- 4.03 days; P = .917).


CONCLUSIONS
These results do not demonstrate a benefit for prophylactic use of nesiritide on the incidence of dialysis and/or death in patients undergoing high-risk cardiac surgery. Although nesiritide may provide some renal protection in the immediate postoperative period, no effect on length of stay was observed.
Ejaz
A Ahsan
AA
Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610-0224, USA. ejazaa@medicine.ufl.edu
Martin
Tomas D
TD
Johnson
Richard J
RJ
Winterstein
Almut G
AG
Klodell
Charles T
CT
Hess
Philip J
PJ
Ali
Ayad K
AK
Whidden
Elaine M
EM
Staples
Nancy L
NL
Alexander
James A
JA
House-Fancher
Mary Ann
MA
Beaver
Thomas M
TM
D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007668:Kidney / Q000187:drug effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000517:prevention & control; D006435:Renal Dialysis; D012307:Risk Factors
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D003404:Creatinine