Copia autorizada por CDR Circulation, Jun 30 2014, Vincent M. van Deursen, Adrian F. Hernandez, Amanda Stebbins, Vic Hasselblad, Justin A. Ezekowitz, Robert M. Califf, Stephen S. Gottlieb, Christopher M. O’Connor, Randall C. Starling, W.H. Wilson Tang, John J. McMurray, Kenneth Dickstein, Adriaan A. Voors,
- 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.).
- Correspondence to Adriaan A. Voors, MD, PhD, Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. E-mail firstname.lastname@example.org
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.
Methods and 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 (25th–75th 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.