title: Nesiritide, renal function, and associated outcomes during hospitalization for acute decompensated heart failure: results from the Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure (ASCEND-HF).
abstract: BACKGROUND
  Contradictory results have been reported on the effects of nesiritide on renal function in patients with acute decompensated heart failure. We studied the effects of nesiritide on renal function during hospitalization for acute decompensated heart failure and associated outcomes.
  
  
  RESULTS
  A total of 7141 patients were randomized to receive either nesiritide or placebo and creatinine was recorded in 5702 patients at baseline, after infusion, discharge, peak/nadir levels until day 30. Worsening renal function was defined as an increase of serum creatinine >0.3 mg/dL and a change of ≥25%. Median (25(th)-75(th) percentile) baseline creatinine was 1.2 (1.0-1.6) mg/dL and median baseline blood urea nitrogen was 25 (18-39) mmol/L. Changes in both serum creatinine and blood urea nitrogen were similar in nesiritide-treated and placebo-treated patients (P=0.20 and P=0.41) from baseline to discharge. In a multivariable model, independent predictors of change from randomization to hospital discharge in serum creatinine were a lower baseline blood urea nitrogen, higher systolic blood pressure, lower diastolic blood pressure, previous weight gain, and lower baseline potassium (all P<0.0001). The frequency of worsening renal function during hospitalization was similar in the nesiritide and placebo group (14.1% and 12.8%, respectively; odds ratio with nesiritide 1.12; confidence interval, 0.95-1.32; P=0.19) and was not associated with death alone and death or rehospitalization at 30 days. However, baseline, discharge, and change in creatinine were associated with death alone and death or rehospitalization for heart failure (all tests, P<0.0001).
  
  
  CONCLUSIONS
  Nesiritide did not affect renal function in patients with acute decompensated heart failure. Baseline, discharge, and change in renal function were associated with 30-day mortality or rehospitalization for heart failure.
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Vincent M
authors: VM
authors: van Deursen
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Adrian F
authors: AF
authors: Hernandez
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Amanda
authors: A
authors: Stebbins
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Vic
authors: V
authors: Hasselblad
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Justin A
authors: JA
authors: Ezekowitz
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Robert M
authors: RM
authors: Califf
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Stephen S
authors: SS
authors: Gottlieb
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Christopher M
authors: CM
authors: O'Connor
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Randall C
authors: RC
authors: Starling
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: W H Wilson
authors: WH
authors: Tang
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: John J
authors: JJ
authors: McMurray
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.).
authors: Kenneth
authors: K
authors: Dickstein
authors: From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (V.M.v.D., A.A.V.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.F.H., A.S., V.H., C.M.O., R.C.S.); Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); University of Maryland Hospital, Division of Cardiology, Baltimore, MD (S.S.G.); Cleveland Clinic Foundation, Cleveland, OH (W.H.W.T.); British Heart Foundation Cardiovascular Research Centre, Glasgow, Scotland, UK (J.J.M.); and Central Hospital Cardiology Division, Stavanger, Norway (K.D.). a.a.voors@umcg.nl.
authors: Adriaan A
authors: AA
authors: Voors
mesh_terms: D000208:Acute Disease; D000368:Aged; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000494:pharmacology / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D003404:Creatinine
keywords: heart failure; nesiritide; renal insufficiency