The Effect of Nesiritide on Renal Function and Other Clinical Parameters in Patients With Decompensated Heart Failure and Preserved Ejection Fraction

Abstract

The role of nesiritide in patients with decompensated heart failure with preserved ejection fraction (dHFpEF) has not been previously studied. In this investigation, the authors retrospectively analyzed the effect of nesiritide on renal function and clinical outcomes in patients admitted with dHFpEF. Of the 658 patients included, 328 were treated with nesiritide while 330 patients were treated with standard diuretic therapy. In both the nesiritide and no nesiritide groups, there was a significant change in mean glomerular filtration rate (GFR) and creatinine at 72 hours as well as at day of discharge (P<.001). This trend did not progress at 1 month in the nesiritide group, although it did in the no nesiritide group. At 1 month after therapy, however, there was a significant difference between the two groups in the mean change of GFR and creatinine (P<.001). There was no significant difference in >25% decrease of GFR anytime through day 30 (25% vs 29.69%, P=.236) between the two groups. On multivariate analysis, nesiritide was an important predictor of renal function at 1 month (P<.05). Thus, nesiritide can be administered safely without negatively impacting long-term renal function in patients admitted with dHFpEF.

Silent disease progression in clinically stable heart failure

“…However, conflicting findings have been observed on the efficacy and safety of nesiritide in subsequent studies. Some studies (including ADHERE) showed a similar or decreased risk of short‐term mortality or worsening renal function with nesiritide vs. comparators, while findings from meta‐analyses have shown an increased risk of short‐term death and worsening renal function . In the ASCEND‐HF trial, nesiritide was associated with a modestly reduced symptom burden compared with conventional therapy in European but not American patients with acute decompensated HF, and did not affect rates of death or rehospitalization.…”

Natriuretic Peptides in Heart Failure with Preserved Left Ventricular Ejection Fraction: From Molecular Evidences to Clinical Implications

“…The rationale behind using NPs as a therapeutic target in HF therapy [45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62] resides in the seemingly abnormal BNP processing with a subsequent deficiency in active forms and resistance to their biological effects in these patients [5]. It seems that HF patients are deficient in biologically active BNP32 with a subsequent increase in BNP1–108 [45].…”

Recombinant Brain Natriuretic Peptide for the Prevention of Contrast-Induced Nephropathy in Patients with Chronic Kidney Disease Undergoing Nonemergent Percutaneous Coronary Intervention or Coronary Angiography: A Randomized Controlled Trial

“…These findings indicate that BNP administration may have beneficial effects on renal function recovery after CM exposure. Among other functions described previously [ 13 – 15 ], BNP was shown to positively affect the renal function [ 16 – 18 ], for example, increasing renal blood flow and glomerular filtration rate [ 19 ].…”

“…Interestingly, BNP infusion not only inhibits the systemic and regional (renal and cardiac) sympathetic tones [ 13 ] as well as the RAAS [ 14 ], but also decreases endothelin release [ 15 ]. Furthermore, BNP has multiple beneficial effects on renal function [ 16 – 18 ]. With respect to vasodilatation, BNP may increase renal blood flow and glomerular filtration rate [ 19 ].…”