Lack of association between worsening renal function and mortality in heart failure patients treated with nesiritide

Background: Nesiritide is approved for the treatment of decompensated heart failure. Because nesiritide may exacerbate renal dysfunction, it has been claimed that there may be a link between worsening renal function caused by nesiritide and increased mortality. Aims: We analyzed our inpatient experience with nesiritide to determine if changes in renal function were associated with worsened mortality. Methods and results: A retrospective study of 167 patients [65% male, median age 70 years, left ventricular ejection fraction (LVEF) 30%, glomerular filtration rate (GFR) 36 mL/min/1.73 m², serum creatinine (sCr)1.8 mg/dL] treated with standard dose nesiritide was undertaken for the period September 2001-March 2005. Mortality was 12.5% at 1 month and 51% at 24 months (median follow-up was 5.4 months [interquartile ranges (IQR) 1.3, 18.6]. Higher mortality was associated with lower pre-infusion GFR (hazard ratio for a 10 mL/min/1.72 m² decrease = 1.22, p = 0.004). Pre-to-post nesiritide changes in GFR (median 0.0, IQR-5.8, 8.4; p = 0.51) and creatinine (median 0.0, IQR - 0.3, 0.3; p = 0.91), however, were not significant and not detected to be associated with worsened mortality by Cox proportional hazards (p = 0.46 and p = 0.40, respectively). Conclusions: While we found that nesiritide infusion in decompensated heart failure patients worsened renal function (decrease in GFR) in 29% of patients, changes in renal function could not be related to an incremental worsening of mortality. Our findings do not support an association of worsening renal function and worsening mortality after nesiritide.