Cardiovascular and renal effects of low dose brain natriuretic peptide infusion in man.

Villa, Giorgio La; Fronzaroli, Caterina; Lazzeri, Chiara; Porciani, Cristina; Bandinelli, R; Vena, Silvio; Messeri, Gianni; Franchi, F

doi:10.1210/jcem.78.5.8175974

Cited by 34 publications

(33 citation statements)

References 24 publications

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“…Similarly, studies of BNP have come to conflicting conclusions about the effects on glomerular filtration rate (GFR) or renal plasma flow. [5][6][7] The extent of the renal effects of nesiritide when given in therapeutic doses to decompensated CHF patients is uncertain.…”

Section: See P 1514mentioning

confidence: 99%

“…[11][12][13][14] Human studies that have demonstrated improved GFR have generally evaluated a small number of normal individuals. 5,15 Even these studies, however, have not necessarily demonstrated improved ERPF. 6 Nesiritide appears to exert hemodynamic effects in patients with both CHF and renal dysfunction (although the effects may be quantitatively different from those seen in normal individuals).…”

Section: Gfr and Erpfmentioning

confidence: 99%

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Nesiritide Does Not Improve Renal Function in Patients With Chronic Heart Failure and Worsening Serum Creatinine

et al. 2004

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Background-Nesiritide (synthetic human brain natriuretic peptide) is approved for the treatment of symptomatic heart failure. However, studies of brain natriuretic peptide in patients with heart failure have come to conflicting conclusions about effects on glomerular filtration rate (GFR), effective renal plasma flow, natriuresis, and diuresis. Methods and Results-To identify a population at high risk of renal dysfunction with conventional treatment, we selected patients with a creatinine level increased from baseline (within 6 months). We examined the effects of nesiritide on GFR (measured by iothalamate clearance), renal plasma flow (measured by para-amino hippurate clearance), urinary sodium excretion, and urine output in a double-blind, placebo-controlled, crossover study. Patients received nesiritide (2 g/kg IV bolus followed by an infusion of 0.01 g/kg per minute) or placebo for 24 hours on consecutive days. Nesiritide and placebo data were compared by repeated-measures analysis and Student t test. We studied 15 patients with a recent mean baseline creatinine of 1.5Ϯ0.4 mg/dL and serum creatinine of 1.8Ϯ0.8 mg/dL on admission to the study. There were no differences in GFR, effective renal plasma flow, urine output, or sodium excretion for any time interval or for the entire 24-hour period between the nesiritide and placebo study days. For 24 hours, urine output was 113Ϯ51 mL/h with placebo and 110Ϯ56 mL/h with nesiritide. GFR during placebo was 40.9Ϯ25.9 mL/min and with nesiritide was 40.9Ϯ25.8. Conclusions-Nesiritide did not improve renal function in patients with decompensated heart failure, mild chronic renal insufficiency, and renal function that had worsened compared with baseline. The lack of effect may be related to renal insufficiency, hemodynamic alterations, sodium balance, severity of heart failure, or drug dose. Understanding the importance of these issues will permit effective and appropriate use of nesiritide.

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Section: See P 1514mentioning

confidence: 99%

Section: Gfr and Erpfmentioning

confidence: 99%

Nesiritide Does Not Improve Renal Function in Patients With Chronic Heart Failure and Worsening Serum Creatinine

et al. 2004

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“…Although most but not all studies in healthy humans reported that BNP infusion increases glomerular filtration rate, 1,[5][6][7] renal plasma flow has been found to decrease, 1,7 to increase, 5 or to remain unchanged. 3,8 Variations in the renovascular effects of BNP could be related to differences in BNP levels reached during the experiments, but it is equally possible that the renal changes are, in part, secondary to systemic effects.…”

mentioning

confidence: 95%

“…S ystemic infusion of brain natriuretic peptide (BNP) stimulates natriuresis and diuresis [1][2][3][4][5][6] and inhibits plasma renin activity [1][2][3]7,8 but has variable effects on the renal vasculature. Although most but not all studies in healthy humans reported that BNP infusion increases glomerular filtration rate, 1,[5][6][7] renal plasma flow has been found to decrease, 1,7 to increase, 5 or to remain unchanged.…”

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confidence: 99%

Does Brain Natriuretic Peptide Have a Direct Renal Effect in Human Hypertensives?

Zander

Houben²,

Wierema³

et al. 2003

Hypertension

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Abstract-Systemic infusion of brain natriuretic peptide (BNP) stimulates natriuresis and diuresis but has variable effects on the renal vasculature. In this study, we investigated whether BNP has any direct effects on the kidney in hypertensive patients. Three stepwise increasing doses of BNP (60, 120, and 180 pmol/min) or placebo were infused into the renal artery of 26 hypertensive patients. Renal blood flow was determined with the 133 Xenon washout technique. Before and after infusion of BNP, arterial and venous blood samples were taken for cGMP, renin, and creatinine concentration. Intra-arterial blood pressure and heart rate were monitored continuously. Intrarenal BNP infusion did not induce significant changes in renal blood flow despite increases in circulating levels of cGMP. The latter, however, was not associated with changes in the cGMP gradient across the kidney. In addition, we did not find any BNP-related changes in the secretion of active renin and in creatinine extraction. At the highest dose, heart rate increased after BNP infusion without a change in mean intra-arterial blood pressure. In conclusion, this study suggests that at least in hypertensive subjects, BNP has no direct intrarenal hemodynamic effects and that the rise in circulating cGMP without changes in net renal extraction of this second messenger is related to a primary extrarenal target of BNP. Key Words: natriuretic peptides Ⅲ vasodilation Ⅲ hypertension, renal Ⅲ human Ⅲ kidney Ⅲ hemodynamics Ⅲ vasoconstriction Ⅲ hormones S ystemic infusion of brain natriuretic peptide (BNP) stimulates natriuresis and diuresis 1-6 and inhibits plasma renin activity [1][2][3]7,8 but has variable effects on the renal vasculature. Although most but not all studies in healthy humans reported that BNP infusion increases glomerular filtration rate, 1,5-7 renal plasma flow has been found to decrease, 1,7 to increase, 5 or to remain unchanged. 3,8 Variations in the renovascular effects of BNP could be related to differences in BNP levels reached during the experiments, but it is equally possible that the renal changes are, in part, secondary to systemic effects. Indeed, BNP not only acts on the kidney but also affects blood pressure, heart rate, cardiac output, and systemic vascular resistance. 2,3,5,6,8,9 In those studies in which changes in renal plasma flow are reported, it is important to keep in mind that such alterations may simply be due to concurrent changes in cardiac output. If, for instance, renal fraction (that is, the proportion of cardiac output perfusing the kidneys) remains unaltered during systemic BNP infusion, it is unlikely that the peptide has exerted a direct effect on the renal vasculature. If, on the other hand, renal fraction increases, relative renal vasodilation must have occurred. In most studies, this has not been taken into account.Local administration of BNP in a regional vascular bed in amounts that will not have systemic effects allows for assessing whether BNP has any direct effects on certain parts of the circulation. Wi...

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“…It was also found to have diuretic and natriuretic properties. 30 BNP (nesiritide) is well tolerated. Its most signifi cant adverse effect is dose-related hypotension, which occurs in 4%-5% of patients.…”

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confidence: 99%

B‐Natriuretic Peptide for the Prevention of Radiocontrast‐Induced Nephropathy

Kamalakannan

Lattupalli

Mesiha

et al. 2008

Dialysis & Transplantation

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BACKGROUND: The hypothesis of the study was that infusion of B-natriuretic peptide (BNP), by increasing renal vasodilatation and glomerular fi ltration, would reduce the incidence of radiocontrast nephropathy (RCIN) after cardiac catheterization in patients with preexisting renal insuffi ciency. METHODS:The study was a single-center, prospective, randomized, double-blind, placebo-controlled pilot study of 50 patients. Patients with a baseline serum creatinine (SCr) Ͼ 1.5 mg/dL not on dialysis undergoing elective cardiac catheterization with visipaque (nonionic, iso-osmolal contrast) were enrolled. Patients were randomly assigned to receive intravenous BNP or placebo infusion. RCIN was defi ned as SCr increase Ն 0.5 mg/dL at 48 hours post-contrast administration.RESULTS: There were no signifi cant differences in baseline characteristics between the 2 groups. The incidence of RCIN was 3.8% (1 of 26) in the BNP group versus 12.5% (3 of 24) in the placebo group (p ϭ 0.340). None of the patients who developed RCIN required renal replacement therapy, and all their SCr values returned to baseline on posthospital follow-up. On logistic regression only the baseline SCr was an independent predictor of RCIN.CONCLUSIONS: BNP infusion shows a nonsignifi cant trend of reduction in the incidence of RCIN in patients with chronic renal insuffi ciency undergoing elective cardiac catheterization. Further large-scale trials are needed to determine the usefulness of BNP infusion to prevent RCIN.

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Cardiovascular and renal effects of low dose brain natriuretic peptide infusion in man.

Cited by 34 publications

References 24 publications

Nesiritide Does Not Improve Renal Function in Patients With Chronic Heart Failure and Worsening Serum Creatinine

Nesiritide Does Not Improve Renal Function in Patients With Chronic Heart Failure and Worsening Serum Creatinine

Does Brain Natriuretic Peptide Have a Direct Renal Effect in Human Hypertensives?

B‐Natriuretic Peptide for the Prevention of Radiocontrast‐Induced Nephropathy

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