Nesiritide, Renal Function, and Associated Outcomes During Hospitalization for Acute Decompensated Heart Failure: Results From ASCEND-HF
Background—Contradictory results have been reported on the effects of nesiritide on renal function in patients with acute decompensated heart failure (ADHF). We studied the effects of nesiritide on renal function during hospitalization for ADHF and associated outcomes.
Methods and Results—A total of 7141 patients were randomized to receive either nesiritide or placebo and creatinine was recorded in 5702 patients at baseline, after infusion, discharge, peak/nadir levels until day 30. Worsening renal function was defined as an increase of serum creatinine >0.3 mg/dL and a change of greater than or equal to 25%. Median (25th-75th percentile) baseline creatinine was 1.2 (1.0-1.6) mg/dL and median baseline blood urea nitrogen (BUN) was 25 (18-39) mmol/L. Changes in both serum creatinine and BUN were similar in nesiritide-treated and placebo-treated patients (p=0.20 and p=0.41) from baseline to discharge. In a multivariable model, independent predictors of change from randomization to hospital discharge in serum creatinine were a lower baseline BUN, higher systolic blood pressure, lower diastolic blood pressure, prior weight gain, and lower baseline potassium (all p<0.0001). The frequency of worsening renal function during hospitalization was similar in the nesiritide and placebo group (14.1% and 12.8%, respectively; odds ratio with nesiritide 1.12 [0.95-1.32], p=0.19) and was not associated with death alone and death or re-hospitalization at 30 days. However, baseline, discharge, and change in creatinine were associated with death alone and death or re-hospitalization for heart failure (all tests, p<0.0001).
Conclusions—Nesiritide did not affect renal function in patients with ADHF. Baseline, discharge, and change in renal function were associated with 30-day mortality or re-hospitalization for heart failure.
Clinical Trial Registration Information—clinicaltrials.gov. Identifier: NCT00475852.
- Received April 4, 2013.
- Revision received May 13, 2014.
- Accepted June 30, 2014.