Long-term outcome of patients treated with prophylactic nesiritide for the prevention of acute kidney injury following cardiovascular surgery.
BACKGROUND
Previously, we reported that the prophylactic use of nesiritide did not reduce the incidence of dialysis or death following cardiovascular (CV) surgery despite reducing the incidence of acute kidney injury (AKI) in the immediate postoperative period. Therefore, we investigated whether the observed renal benefits of nesiritide had any long-term impact on cumulative patient survival and renal outcomes.


METHODS
Participants of the Nesiritide Study, a previously reported prospective, double-blind, placebo-controlled, randomized clinical trial investigating the effect of nesiritide on the incidence of dialysis or death at 21 days in adult patients undergoing high-risk CV surgery, were included in the study. Data of the participants' most recent health and renal function status were obtained using institutional review board-approved patient questionnaires, medical records, and the database of the Social Security Administration.


RESULTS
Data on all 94 patients from the Nesiritide Study were obtained. The mean follow-up period was 20.8 +/- 10.4 months. No differences in cumulative survival between the groups were noted at follow-up (nesiritide 77.7% vs placebo 81.6%, P = 0.798). Patients with in-hospital incidence of AKI had a higher rate of mortality than those with no AKI (AKI 41.4% vs no AKI 10.7%, P = 0.002). However, differences in survival time were not significant between the groups when the analysis was restricted to patients with AKI (nesiritide 16.8 +/- 4 months vs placebo 18.5 +/- 2.3 months, P = 0.729).


CONCLUSIONS
Renoprotection provided by nesiritide in the immediate postoperative period was not associated with improved long-term survival in patients undergoing high-risk CV surgery.
Lingegowda
Vijaykumar
V
Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610-0224, USA.
Van
Quoc C
QC
Shimada
Michiko
M
Beaver
Thomas M
TM
Dass
Bhagwan
B
Sood
Puneet
P
Ejaz
A Ahsan
AA
D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D010919:Placebos; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome
D045283:Natriuretic Agents; D010919:Placebos; D020097:Natriuretic Peptide, Brain
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