Natriuretic and Neurohormonal Responses to Nesiritide, Furosemide, and Combined Nesiritide and Furosemide in Patients With Stable Systolic Dysfunction

Abstract

Background: In patients with heart failure, few data describe the neurohormonal response to nesiritide and furosemide either alone or in combination. This study systematically compared the effects of nesiritide, furosemide, and their combination on natriuresis/diuresis and plasma aldosterone in patients with chronic stable heart failure who were relatively diuretic resistant. Hypothesis: Natriuretic, diuretic, and neurohormonal responses to furosemide and nesiritide will differ when these agents are administered alone vs. in combination. Methods: Twenty-eight subjects completed a multicenter, open-label, three-arm crossover study. Each subject received the following treatments in random order on alternate days: (1) furosemide, 40 mg intravenousbolus; (2) nesiritide, 2 μg/kg intravenous bolus followed by a 0.01 μg/kg/min infusion for 6 hours; (3) both furosemide and nesiritide, with furosemide given at least 15 minutes after initiation of nesiritide. Results: Plasma aldosterone increased by 2.2 ± 1.6 ng/dL after furosemide alone, decreased by 3.9 ± 1.6 ng/dL after nesiritide alone (P = 0.005 vs furosemide alone and P = 0.56 vs furosemide plus nesiritide), and decreased by 2.8 ± 1.6 ng/dL after furosemide plus nesiritide (P = 0.02 vs furosemide alone). Conclusions: Furosemide alone produced natriuresis/diuresis and a prompt rise in plasma aldosterone values. Nesiritide alone produced no significant natriuresis/diuresis,but decreased plasma aldosterone values. When furosemide was administered on a background of nesiritide infusion, the observed natriuresis/diuresis was similar to that seen with furosemide alone, without the anticipated increase in plasma aldosterone observed with furosemide alone.

Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study

“…Until now the use of ultrafiltration has been limited for mainly technical reasons, however, recent technological advances in the new devices and the results of the UNLOAD trial have encouraged the wider use of ultrafiltration in these patients. Moreover, our findings show that the fluid removal obtained with ultrafiltration in the acute phase had more beneficial effects on biohumoral variables, namely aldosterone and NT‐proBNP, and haemodynamic variables compared with the diuretic infusion 20…”

Results of Low-Dose Human Atrial Natriuretic Peptide Infusion in Nondialysis Patients With Chronic Kidney Disease Undergoing Coronary Artery Bypass Grafting

“…Sica et al (16) performed very interesting research on this point. They conducted a comparative study on acute heart failure patients divided into 3 groups: nesiritide, furosemide, and nesiritide and furosemide concomitantly.…”

Early Results of Human Atrial Natriuretic Peptide Infusion in Non-Dialysis Patients with Chronic Kidney Disease Undergoing Isolated Coronary Artery Bypass Grafting: the NU-HIT Trial for CKD-II

“…In the furosemide group, the urinary sodium excretion rate was significantly higher than in the nesiritide group, but the aldosterone value was significantly lower in the nesiritide group than in the furosemide group, indicating that neurohormonal activation plays an important role in shaping diuretic responsiveness in heart failure patients. 22) In this study, there were three reasons why the FENa value was high in the placebo group. The first reason is that the furosemide dose was significantly higher in the placebo group (hANP group: 11.5 ± 28.0 mg, placebo group: 54.0 ± 69.5 mg, p <0.0001).…”