Effect of nesiritide on renal function: a retrospective review

Objectives: Recent meta-analysis has demonstrated that nesiritide may worsen renal function (RF) in patients with acute decompensated heart failure (ADHF). A nesiritide utilization evaluation (NUE) performed in our institution reflected that belief of RF preservation was one reason leading to nesiritide overuse. This study examined the effect of nesiritide on RF in patients evaluated in this NUE.

Research design and methods: Nesiritide patient records from October 1, 2003 to March 31, 2004 were reviewed (n = 162). Pertinent demographics, laboratory and medication utilization data were obtained.

Main outcome measures: Changes in creatinine clearance (CrCl) and percentage of patients demonstrating worsening RF (decrease in CrCl > or = 25%) during diuretics therapy before nesiritide initiation and during nesiritide initiation and during nesiritide therapy were compared using Wilcoxon Signed-Ranks test and Chi-Square respectively.

Results: Overall, the addition of nesiritide to IV furosemide did not clinically change RF as compared to the use of IV furosemide alone (% change in CrCl: 0 vs. -2.13 mL/min, p = 0.023), although the difference was statistically significant. When categorized into different RF, there is no different in CrCl changes between the nesiritide group and the IV furosemide alone group. There is also no difference in terms of number of patients experiencing > or = 25% reduction in CrCl overall. Changes in RF were also not correlated to dose or duration of therapy.

Conclusion: Nesiritide did not demonstrate significant impact in RF. Larger studies that examine RF in a more systematic and controlled manner and relate changes in RF to clinical outcomes are necessary to further elucidate the risk versus benefit profile of nesiritide.