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.
