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Nesiritide Safe on Renal Function at Low Doses in Patients With Congestive Heart Failure: Presented at ACC

By Danny Kucharsky

NEW ORLEANS, LA -- March 28, 2007 -- Nesiritide therapy at low doses is safe and is not associated with significant deterioration in renal function compared with conventional therapy among patients with congestive heart failure (CHF), according to results of a study presented here at the 56^th annual scientific session of the American College of Cardiology (ACC).

The retrospective chart review of patients admitted with acute decompensated CHF was conducted because studies addressing the effects of nesiritide on renal function in such patients "are limited and have shown conflicting results," said lead investigator Sandeep Arora, MD, internal medicine specialist, Western Pennsylvania Hospital, Pittsburgh, Pennsylvania, United States.

In an oral presentation on March 25^th, Dr. Arora noted that worsening of renal function is seen in around 30% of patients who are hospitalised for CHF, and this may be associated with poorer outcomes.

In their study, Dr. Arora and colleagues reviewed 176 charts of patients admitted with acute CHF at Western Pennsylvania Hospital from 2003 to 2005. Among these patients, 86 received nesiritide and 90 received conventional therapy. The 2 groups had similar baseline characteristics, co-morbidities and standard heart failure medication usage.

Serum creatinine levels and body weight were measured on admission (or within 4 hours of administration of diuretics/nesiritide) and were compared with levels at day 3 or at the end of the therapy.

Worsening renal function was defined as rise in serum creatinine of 0.3 mg/dL or more from baseline and final creatinine level > 1.3 mg/dL. To negate the effect of excessive diuresis on serum creatinine, the investigators calculated a parameter -- change in creatinine/change/ weight/day.

The chart review found there was a higher incidence of chronic renal insufficiency in the nesiritide group than in the control group (P = .028). A similar number of patients in both groups in the control group and in the nesiritide group developed worsening of renal function (30% vs 29.1%, P > .05).

Mean change in creatinine in the nesiritide group was 0.19 mg/dL and 0.16 mg/dL in control group (P = .15). Mean change in weight was 2.06 kg in the nesiritide group and 1.78 kg in the control (P = .17). Mean change in creatinine/change/ weight/day was 0.28 mg/dL/kg/d in the nesiritide group and 0.35 mg/dL/kg/d in the control group (P = .24).

The researchers found no correlation between dose of nesiritide and worsening of renal function. Nesiritide was well tolerated; 2 patients developed transient hypotension compared with 1 in the control group.

While the study showed nesiritide is safe in low doses for patients with CHF, Dr. Arora noted that it had its limitations as it was a retrospective review that did not collect long-term data on renal function and mortality beyond index hospitalisation.


[Presentation title: Effect of Nesiritide on Renal Functions in Patients With Acute Decompensated Congestive Heart Failure. Abstract 1004-68]

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