A retrospective characterization of worsening renal function in patients with acute decompensated heart failure receiving nesiritide
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Keywords
Natriuretic Peptide, Brain, Heart Failure, Mortality
Abstract
Nesiritide is approved by Food and Drug Administration (FDA) for the treatment of patients with acute decompensated heart failure (ADHF) due its ability to rapidly reduce cardiac filling pressures and improve dyspnea. Numerous studies have shown that renal dysfunction is associated with unfavorable outcomes in patients with heart failure. In addition, there have been reports suggesting that nesiritide may adversely affect renal function and mortality.
Objective: The purpose of this retrospective analysis was to assess the effect of dose and duration of nesiritide use and the dose and duration of diuretic therapy on worsening renal function and increased in-hospital mortality in this patient population.
Methods: Seventy-five patients who were hospitalized for ADHF and who were treated with nesiritide for at least 12 hours were reviewed retrospectively.
Results: The mean increase in SCr was 0.5 mg/dL (range 0 – 4.4 mg/dL). Thirty-six percent of patients (27/75) met the primary endpoint with an increase in SCr>0.5 mg/dL. Treatment dose and duration of nesiritide did not differ between those patients who had an increase in SCr>0.5 mg/dL and those who did not (p=0.44 and 0.61). Concomitant intravenous diuretics were used in 85% of patients with an increase in SCr >0.5 mg/dL compared to 90% of patients without an increase in SCr>0.5 mg/dL (p=0.57). The in-hospital mortality rate was also higher at 35% in those patients with an increase in creatinine >0.5 mg/dL compared to 11% in those without (p=0.01).
Conclusion: Nesiritide was associated with an increase in SCr > 0.5 mg/dL in approximately one-third of patients. The increase occurred independently of dose, duration of nesiritide therapy, blood pressure changes, and concomitant intravenous diuretic use. However, the increase in SCr was associated with an increase in hospital stay and in hospital mortality consistent with previous reports in the literature.
References
2. DiDomenico RJ, Park HY, Southworth MR, Eyrich HM, Lewis RK, Finley JM. Guidelines for Acute Decompensated Heart Failure Treatment. Ann Pharmacother. 2004;38:649-660.
3. The Task Force on Acute Heart Failure of the European Society of Cardiology. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Eur Heart J. 2005; 26:384-416.
4. Scios Inc. Natrecor (nesiritide) prescribing information. Fremont, CA; 2005.
5. Mills RM, LeJemtel TH, Horton DP, Liang C, Lang R, Silver MA. Sustained hemodynamic effects of an infusion of nesiritide in heart failure. J Am Coll Cardiol. 1999;34:155-162.
6. Colucci WS, Elkayam U, Horton DP, Abraham WT, Bourge RC, Johnson AD. Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. N Engl J Med. 2000;343:246-253.
7. Young JB, Abraham WT, Warner-Stevenson L, Horton DP, Elkayam U, Bourge RC. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure. JAMA. 2002;287:1531-1540.
8. Sackner-Bernstein JD, Skopicki HA, Aaronson KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation. 2005;111:1487-1491.
9. Sackner-Bernstein JD, Kowalski M, Fox M, Aaronson K. Short-term risk of death after treatment with nesiritide for decompensated heart failure. JAMA. 2005;293:100-1905.
10. Scios Inc. Natrecor (nesiritide) prescribing information. Fremont, CA;2005.
11. Panel of cardiology experts provides recommendations to Scios regarding Natrecor [press release]. Fremont, CA: Scios Inc.; June 13, 2005. Available from http://www.sciosinc.com/scios/press/2005 (accessed April 11, 2007).
12. Scios Announces Recommended Use Initiative for Natrecor [press release]. Fremont, CA: Scios Inc.; August 22, 2005. Available from http://www.sciosinc.com/scios/press/2005 (accessed April 11, 2007).
13. Heywood JT. Combining nesiritide with high-dose diuretics may increase the risk of increased serum creatinine. Circulation. 2005;112:451-452.
14. Butler J, Forman DE, Abraham WT, Gottlieb SS, Loh E, Massi BM. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am J Cardiol. 2004;147:331-338.
15. Krumholz HM, Chen YT, Vaccarino V, Wang Y, Radford MJ, Bradford WD. Correlates and impact on outcomes of worsening renal function in patients ≥ 65 year of age with heart failure. Am J Cardiol. 2000;85:1110-1113.
16. McAlister FA, Ezekowitz J, Tonelli M, Armstrong PW. Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation. 2004;109:1004-1009.
17. La Villa G, Fronzaroli C, Lazzeri C, Porciani C, Bandinelli R, Vena S. Cardiovascular and renal effects of low dose brain natriuretic peptide infusion in man. J Clin Endocrinol. 1994;78:1166-1171.
18. Koller KJ, Goeddel DV. Molecular biology of the natriuretic peptides and their receptors. Circulation 1992;86:1081-1088.
19. Chow SL, Peng JT, Okamoto MP, Heywood JT. Effect of Nesiritide Duration on Renal Function in Acutely Decompensated Heart Failure Patients. Ann Pharmacother. 2007;41:556-561.