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.

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 (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: 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
• Journal: Circulation (Circulation) Vol. 130 Issue 12 Pg. 958-65 (Sep 16 2014) ISSN: 1524-4539 [Electronic] United States
• PMID: 25074507 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 American Heart Association, Inc.

Chemical References

• Natriuretic Agents
• Natriuretic Peptide, Brain
• Creatinine

Topics

• Acute Disease
• Aged
• Blood Urea Nitrogen
• Creatinine (blood)
• Double-Blind Method
• Female
• Heart Failure (drug therapy, physiopathology)
• Hospitalization
• Humans
• Kidney (drug effects, physiopathology)
• Male
• Middle Aged
• Natriuretic Agents (therapeutic use)
• Natriuretic Peptide, Brain (pharmacology, therapeutic use)
• Proportional Hazards Models
• Retrospective Studies