Caution Advised in Nesiritide Use in Patients with Decompensated Diastolic HF with Right Ventricular Failure
NEW ORLEANS, LA—Nesiritide has been demonstrated to improve symptoms and hemodynamics in patients with left ventricular failure (LVF). Nesiritide's effect on renal function in patients with acute decompensated heart failure (ADHF) and normal LV function was evaluated for the first time and compared in patients with right ventricular failure (RVF) versus patients with no RVF.
Study investigators, led by Iosif Kelesidis, MD of Albert Einstein College of Medicine, Bronx, NY, concluded that nesiritide should be used with caution in patients with RVF and renal failure. The study results were presented at ACC.11, the American College of Cardiology's 60th Annual Scientific Session.
Kelesidis and colleagues reviewed clinical trial data of 657 patients admitted to Albert Einstein College of Medicine with ADHF and normal LV systolic function. Of these, 140 patients had isolated RVF secondary to pulmonary hypertension; 517 patients had normal right ventricular function. In the RVF group, 70 were treated with IV nesiritide while the remaining 70 patients received only IV furosemide (control). In the non-RVF group, 258 received nesiritide and 259 received furosemide. Serum creatinine and glomerular filtration rate (GFR) levels at baseline, 3 days, time of discharge, and 1 month post-treatment were assessed.
A significant difference was observed between the RVF and non-RVF nesiritide groups in the mean change of GFR at 1 month (-8.22 ± 8.98 vs. 3.55 ± 19.88; P<0.001). See Figure. There was no significant difference in ≥25% decrease of GFR anytime through Day 30 (22.85% vs. 25.56%; P=0.383) between the two groups. On multivariate analysis, nesiritide was a negative predictor of renal function at 1 month for the RVF group (P<0.01), but a positive predictor for the non-RVF group (P<0.01). Similar results were noted for all groups when creatinine data was used.
Study investigators concluded that caution should be exercised when using nesiritide in patients with RVF and renal failure. It was noted, however, that patients with normal RV function appeared to recover their renal function at 1 month after nesiritide infusion, despite an initial significant deterioration.