Effectiveness of nesiritide on dialysis or all‐cause mortality in patients undergoing cardiothoracic surgery

Abstract

SummaryBackground: Natriuretic peptides have been shown to have favorable renal effects. However, recent evidence suggests potential renal side effects in patients with congestive heart failure.Hypothesis: This study examined the effect of nesiritide (human B-type natriuretic peptide) on hemodialysis or death in patients undergoing cardiothoracic surgery.Methods: This retrospective cohort study included patients (n = 940) undergoing nontransplant adult cardiothoracic surgery between July 2001 and February 2004. Patients receiving nesiritide within 3 days after and not before surgery (n = 151) were compared with those not given nesiritide (n = 789) for incidence of hemodialysis or in-hospital death by Day 21 (HD/death). Patients with preexisting dialysis and intraoperative deaths were excluded. Forward inclusion multiple logistic regression was used based on published risk factors for HD/death.Results: Of 940 patients (318 coronary artery bypass graft, 348 valve, and 274 thoracic aorta), 36 required dialysis and 60 patients died (HD/death; n = 77). Adjusted for significant con-

Effects of Perioperative Nesiritide in Patients With Left Ventricular Dysfunction Undergoing Cardiac Surgery

“…Nesiritide therapy effectively reduces pulmonary capillary wedge pressure and relieves dyspnea in patients hospitalized with acute decompensated heart failure (2)(3)(4). Several small, retrospective, and/or uncontrolled evaluations have suggested beneficial effects in patients undergoing cardiac surgery (7)(8)(9). However, the role of nesiritide in the management of patients undergoing coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) has not been definitively established.…”

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…Although natriuretic peptides have been shown in some studies to reduce the incidence of AKI, the need for RRT was similar, and the overall evidence for these drugs was weak and controversial. [144][145][146][147][148][149][150][151][152] Vasodilatory shock (vasoplegia) has become a common occurrence, particularly with the widespread use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. 153 In a recent RCT of patients with vasoplegic shock (defined as mean arterial pressure <65 mm Hg resistant to fluid challenge and cardiac index >2.2 L/min per m 2 ) after cardiac surgery, vasopressin was associated with lower incidence of severe AKI (stages 2 and 3) and RRT use, although, again, study limitations prevent recommendation and further research is needed.…”

Long‐term Outcome of Patients Treated With Prophylactic Nesiritide for the Prevention of Acute Kidney Injury Following Cardiovascular Surgery

“…1 -4 Previously, we reported in a retrospective study that the use of the B-type natriuretic peptide (BNP) nesiritide (Natrecor) in patients with impaired renal function (serum creatinine [SCr]>1 mg/dL) who were undergoing cardiovascular (CV) surgery was associated with a dramatic reduction in 21-day dialysis-free survival (odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.14-0.87, P = 0.024). 5 However, in a follow-up prospective, randomized clinical trial (the Nesiritide Study), we could not demonstrate a benefit for prophylactic use of nesiritide as related to the incidence of 21-day dialysis and/or death in patients undergoing high-risk CV surgery (nesiritide 6.6% vs control 6.1%; P = 0.914). 6 The study did demonstrate that the prophylactic use of nesiritide was associated with reduced incidence…”