BACKGROUND: Natriuretic peptides have been shown to have favorable renal effects. However, recent evidence suggests potential renal side effects in patients with congestive heart failure. HYPOTHESIS: This study examined the effect of nesiritide (human B-type natriuretic peptide) on hemodialysis or death in patients undergoing cardiothoracic surgery. METHODS: This retrospective cohort study included patients (n = 940) undergoing nontransplant adult cardiothoracic surgery between July 2001 and February 2004. Patients receiving nesiritide within 3 days after and not before surgery (n = 151) were compared with those not given nesiritide (n = 789) for incidence of hemodialysis or in-hospital death by Day 21 (HD/death). Patients with preexisting dialysis and intraoperative deaths were excluded. Forward inclusion multiple logistic regression was used based on published risk factors for HD/death. RESULTS: Of 940 patients (318 coronary artery bypass graft, 348 valve, and 274 thoracic aorta), 36 required dialysis and 60 patients died (HD/death; n = 77). Adjusted for significant confounders (gender, age, procedure, intra-aortic balloon, baseline serum creatinine mg/dl [SCr], 1 day % SCr increase), nesiritide showed a statistically nonsignificant HD/death reduction (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.29-1.17; p = 0.129) in the group as a whole. When stratified by baseline SCr, a significant benefit was noted in patients with SCr > 1.0 (OR, 0.35; 95% CI 0.14-0.87; p = 0.024), while no significant effect was found in patients with SCr < 1.0 (OR, 1.55; 95% CI 0.48-5.07, p = 0.465). CONCLUSIONS: Nesiritide appears promising in reducing the risk of dialysis or death in patients with SCr > 1.0 undergoing cardiothoracic surgery; however, no effect was noted with SCr < 1.0. This study provides strong rationale for a randomized trial.
BACKGROUND: Natriuretic peptides have been shown to have favorable renal effects. However, recent evidence suggests potential renal side effects in patients with congestive heart failure. HYPOTHESIS: This study examined the effect of nesiritide (human B-type natriuretic peptide) on hemodialysis or death in patients undergoing cardiothoracic surgery. METHODS: This retrospective cohort study included patients (n = 940) undergoing nontransplant adult cardiothoracic surgery between July 2001 and February 2004. Patients receiving nesiritide within 3 days after and not before surgery (n = 151) were compared with those not given nesiritide (n = 789) for incidence of hemodialysis or in-hospital death by Day 21 (HD/death). Patients with preexisting dialysis and intraoperative deaths were excluded. Forward inclusion multiple logistic regression was used based on published risk factors for HD/death. RESULTS: Of 940 patients (318 coronary artery bypass graft, 348 valve, and 274 thoracic aorta), 36 required dialysis and 60 patients died (HD/death; n = 77). Adjusted for significant confounders (gender, age, procedure, intra-aortic balloon, baseline serum creatinine mg/dl [SCr], 1 day % SCr increase), nesiritide showed a statistically nonsignificant HD/death reduction (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.29-1.17; p = 0.129) in the group as a whole. When stratified by baseline SCr, a significant benefit was noted in patients with SCr > 1.0 (OR, 0.35; 95% CI 0.14-0.87; p = 0.024), while no significant effect was found in patients with SCr < 1.0 (OR, 1.55; 95% CI 0.48-5.07, p = 0.465). CONCLUSIONS: Nesiritide appears promising in reducing the risk of dialysis or death in patients with SCr > 1.0 undergoing cardiothoracic surgery; however, no effect was noted with SCr < 1.0. This study provides strong rationale for a randomized trial.
Authors: B H Dorman; B R Bond; M J Clair; C A Walker; M L Pinosky; S T Reeves; J M Kratz; J L Zellner; A J Crumbley; M M Multani; F G Spinale Journal: J Cardiothorac Vasc Anesth Date: 2000-10 Impact factor: 2.628
Authors: Alexandra K Kiemer; Nina C Weber; Robert Fürst; Nicole Bildner; Stefanie Kulhanek-Heinze; Angelika M Vollmar Journal: Circ Res Date: 2002-05-03 Impact factor: 17.367
Authors: W S Colucci; U Elkayam; D P Horton; W T Abraham; R C Bourge; A D Johnson; L E Wagoner; M M Givertz; C S Liang; M Neibaur; W H Haught; T H LeJemtel Journal: N Engl J Med Date: 2000-07-27 Impact factor: 91.245
Authors: Ali Mirza Onder; David Rosen; Charles Mullett; Lesley Cottrell; Sherry Kanosky; Oulimata Kane Grossman; Hafiz Imran Iqbal; Eric Seachrist; Lennie Samsell; Kelly Gustafson; Larry Rhodes; Robert Gustafson Journal: Pediatr Crit Care Med Date: 2016-08 Impact factor: 3.624
Authors: Mitra K Nadim; Lui G Forni; Azra Bihorac; Charles Hobson; Jay L Koyner; Andrew Shaw; George J Arnaoutakis; Xiaoqiang Ding; Daniel T Engelman; Hrvoje Gasparovic; Vladimir Gasparovic; Charles A Herzog; Kianoush Kashani; Nevin Katz; Kathleen D Liu; Ravindra L Mehta; Marlies Ostermann; Neesh Pannu; Peter Pickkers; Susanna Price; Zaccaria Ricci; Jeffrey B Rich; Lokeswara R Sajja; Fred A Weaver; Alexander Zarbock; Claudio Ronco; John A Kellum Journal: J Am Heart Assoc Date: 2018-06-01 Impact factor: 5.501