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CARDIOLOGY

Effect of Nesiritide Infusion Duration on Renal Function in Acutely Decompensated Heart Failure Patients

Assistant Professor of Pharmacy Practice, Western University of Health Sciences, Pomona, CA

Jessica T Peng, PharmD

Pharmacy Practice Fellow in Cardiology, Western University of Health Sciences

Mark P Okamoto, PharmD

Associate Professor of Social and Administrative Sciences, Associate Dean of Assessment, Western University of Health Sciences

J Thomas Heywood, MD

Director of the Heart Failure Clinic, Scripps Clinic, La Jolla, CA

Reprints: Dr. Chow, Western University of Health Sciences, 309 E. Second St., Pomona, CA 91766, fax 909/469-5539, SChow{at}westernu.edu

BACKGROUND: Nesiritide, a synthetic B-type natriuretic peptide, is used for the treatment of patients with acutely decompensated heart failure. Although nesiritide has been reported to worsen renal function, as reflected by significant elevations in serum creatinine (SCr), the impact of infusion duration on renal function has not been evaluated.

OBJECTIVE: To investigate the effect of nesiritide infusion duration (<24 h vs 24 h) on worsening renal function in patients with acutely decompensated heart failure.

METHODS: Medical records of hospitalized patients receiving nesiritide were retrospectively reviewed, and 84 consecutive charts of patients with acute decompensated heart failure and available renal function tests were identified for the study. SCr and blood urea nitrogen (BUN) were documented at baseline and during infusion. Worsening renal function was defined as an increase in SCr of 0.5 mg/dL or more or BUN 10 mg/dL or more from baseline.

RESULTS: Univariate analysis showed a significant association between nesiritide infusion duration of 24 hours or more (26.1% vs 2.6%; p = 0.003), high diuretic doses (61.5% vs 32.4%; p = 0.045), and baseline SCr (2.0 ± 0.8 vs 1.5 ± 0.7 mg/dL; p = 0.04) with increases in SCr of 0.5 mg/dL or more. However, only infusion duration of 24 hours or more was statistically significant on multivariate analysis, after adjusting for baseline SCr (OR 10.46; 95% CI 1.26 to 86.72; p = 0.03). Longer duration of infusion was also a consistent variable in both univariate and multivariate analysis when elevated BUN was evaluated (34.8 vs 2.6%; p < 0.001 and OR 19.73; 95% CI 2.47 to 157.46; p = 0.005, respectively).

CONCLUSIONS: Nesiritide infusion of 24 hours or more appears to be significantly associated with elevated markers of worsening renal function in patients with acutely decompensated heart failure compared with infusion of less than 24 hours; however, prospective studies are needed to corroborate this finding.

Key Words: heart failure, nesiritide, renal function

Published Online, March 27, 2007. www.theannals.com, DOI 10.1345/aph.1H589

This article has been cited by other articles:

				S. Arora, K. Clarke, V. Srinivasan, and A. Gradman Effect of nesiritide on renal function in patients admitted for decompensated heart failure QJM, November 1, 2007; 100(11): 699 - 706. [Abstract] [Full Text] [PDF]