title: Comparative effects of nesiritide and nitroglycerin on renal function, and incidence of renal injury by traditional and RIFLE criteria in acute heart failure.
abstract: BACKGROUND
  Acute renal insufficiency is associated with poorer outcomes in heart failure. Data regarding the renal effects of vasodilatory therapy in acute heart failure are inconclusive.
  
  
  OBJECTIVE
  Nesiritide and nitroglycerin are associated with differing effects on the incidence of acute renal injury and glomerular filtration rate changes.
  
  
  METHODS
  A retrospective cohort study of patients hospitalized with acute congestive heart failure who received intravenous nesiritide or nitroglycerin for ≥6 hours. Acute kidney injury was assessed by risk, injury, failure, loss, and end stage (RIFLE) classification (creatinine/GFR criteria) and by traditional acute rise in creatinine of 0.3 mg/dL or 25%. Secondary endpoints included change in estimated glomerular filtration rate, serum creatinine, serum blood urea nitrogen, blood pressure, and urine output.
  
  
  RESULTS
  A total of one hundred and thirty-one patients (age 57 ± 12 years, 67% male, left ventricular ejection fraction 38 ± 35%, 30% ischemic) received nesiritide (N = 37) or nitroglycerin (N = 94). Diuretic regimen and doses were similar in both the groups. Mean duration of therapy was not different (nesiritide 38.6 ± 35.7 h vs nitroglycerin 30.7 ± 22.6 h, P = .13). No differences were detected in incidence of renal injury using either criteria (RIFLE: nesiritide 19% vs nitroglycerin 22%, P = .88; traditional: 22% vs 34%, P = .16); however, glomerular filtration rate declined (-1 ± 18 mL/min vs -9 ± 21 mL/min, P = .03) and blood urea nitrogen increased (-0.2 ± 9.9 mg/dL vs 4.2 ± 9.1 mg/dL, P = .02) to a greater degree with nitroglycerin. Nesiritide was associated with lower hourly blood pressures and a higher incidence of systolic blood pressure <80 mm Hg.
  
  
  CONCLUSIONS
  The incidence of renal injury was not different between nesiritide- and nitroglycerin-treated patients with acute heart failure; however, nitroglycerin was associated with a decline in glomerular filtration rate and increase in blood urea nitrogen despite higher baseline and on treatment blood pressures.
authors.affiliation: University of Southern California School of Pharmacy, Los Angeles, CA 90033, USA.
authors.forename: Tien M H
authors.initials: TM
authors.lastname: Ng
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Ackerbauer
authors.forename: Alifiya F
authors.initials: AF
authors.lastname: Hyderi
authors.forename: Shenche
authors.initials: S
authors.lastname: Hshieh
authors.forename: Uri
authors.initials: U
authors.lastname: Elkayam
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007677:Kidney Function Tests / Q000379:methods / Q000639:trends; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects* / Q000494:pharmacology; D005996:Nitroglycerin / Q000009:adverse effects* / Q000494:pharmacology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D020097:Natriuretic Peptide, Brain; D005996:Nitroglycerin