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. 2010 Apr 8;33(4):217–221. doi: 10.1002/clc.20750

Long‐term Outcome of Patients Treated With Prophylactic Nesiritide for the Prevention of Acute Kidney Injury Following Cardiovascular Surgery

Vijaykumar Lingegowda 1, Quoc C Van 1, Michiko Shimada 1,3, Thomas M Beaver 2, Bhagwan Dass 1, Puneet Sood 1, A Ahsan Ejaz 1,✉
PMCID: PMC6653536  PMID: 20394042

Abstract

Background

Previously, we reported that the prophylactic use of nesiritide did not reduce the incidence of dialysis or death following cardiovascular (CV) surgery despite reducing the incidence of acute kidney injury (AKI) in the immediate postoperative period. Therefore, we investigated whether the observed renal benefits of nesiritide had any long‐term impact on cumulative patient survival and renal outcomes.

Methods

Participants of the Nesiritide Study, a previously reported prospective, double‐blind, placebo‐controlled, randomized clinical trial investigating the effect of nesiritide on the incidence of dialysis or death at 21 days in adult patients undergoing high‐risk CV surgery, were included in the study. Data of the participants' most recent health and renal function status were obtained using institutional review board‐approved patient questionnaires, medical records, and the database of the Social Security Administration.

Results

Data on all 94 patients from the Nesiritide Study were obtained. The mean follow‐up period was 20.8 ± 10.4 months. No differences in cumulative survival between the groups were noted at follow‐up (nesiritide 77.7% vs placebo 81.6%, P = 0.798). Patients with in‐hospital incidence of AKI had a higher rate of mortality than those with no AKI (AKI 41.4% vs no AKI 10.7%, P = 0.002). However, differences in survival time were not significant between the groups when the analysis was restricted to patients with AKI (nesiritide 16.8 ± 4 months vs placebo 18.5 ± 2.3 months, P = 0.729).

Conclusions

Renoprotection provided by nesiritide in the immediate postoperative period was not associated with improved long‐term survival in patients undergoing high‐risk CV surgery. Copyright © 2010 Wiley Periodicals, Inc.

Full Text

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References

  • 1. Rahman SN, Kim GE, Mathew AS, et al. Effects of atrial natriuretic peptide in clinical acute renal failure. Kidney Int 1994; 45: 1731–1738. [DOI] [PubMed] [Google Scholar]
  • 2. Allgren RL, Marbury TC, Rahman SN, et al; for Auriculin Anaritide Acute Renal Failure Study Group. Anaritide in acute tubular necrosis. N Engl J Med 1997; 336: 828–834. [DOI] [PubMed] [Google Scholar]
  • 3. Swärd K, Valsson F, Odencrants P, et al. Recombinant human atrial natriuretic peptide in ischemic acute renal failure: a randomized placebo‐controlled trial [published correction appears in Crit Care Med. 2006;34:1862]. Crit Care Med 2004; 32: 1310–1315. [DOI] [PubMed] [Google Scholar]
  • 4. Lewis J, Salem MM, Chertow GM, et al; for Anaritide Acute Renal Failure Study Group. Atrial natriuretic factor in oliguric acute renal failure. Am J Kidney Dis 2000; 36: 767–774. [DOI] [PubMed] [Google Scholar]
  • 5. Beaver TM, Winterstein AG, Shuster JJ, et al. Effectiveness of nesiritide on dialysis or all‐cause mortality in patients undergoing cardiothoracic surgery. Clin Cardiol 2006; 29: 18–24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Ejaz AA, Martin TD, Johnson RJ, et al. Prophylactic nesiritide does not prevent dialysis or all‐cause mortality in patients undergoing high‐risk cardiac surgery. J Thorac Cardiovasc Surg 2009; 138: 959–964. [DOI] [PubMed] [Google Scholar]
  • 7. Coca SG, Peixoto AJ, Garg AX, et al. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta‐analysis. Am J Kidney Dis 2007; 50: 712–720. [DOI] [PubMed] [Google Scholar]
  • 8. Newsome BB, Warnock DG, McClellan WM, et al. Long‐term risk of mortality and end‐stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Arch Intern Med 2008; 168: 609–616. [DOI] [PubMed] [Google Scholar]
  • 9. Mentzer RM Jr, Oz MC, Sladen RN, et al; for NAPA Investigators. Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: the NAPA Trial. J Am Coll Cardiol 2007; 49: 716–726. [DOI] [PubMed] [Google Scholar]
  • 10. Cooper WA, O'Brien SM, Thourani VH, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 2006; 113: 1063–1070. [DOI] [PubMed] [Google Scholar]
  • 11. Mehta RL, Kellum JA, Shah SV, et al; for Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Lassnigg A, Schmid ER, Hiesmayr M, et al. Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure? Crit Care Med 2008; 36: 1129–1137. [DOI] [PubMed] [Google Scholar]
  • 13. Ishani A, Xue JL, Himmelfarb J, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 2009; 20: 223–228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Davies MG, Saad WE, Peden EK, et al. Implications of acute functional injury following percutaneous renal artery intervention. Ann Vasc Surg 2008; 22: 783–789. [DOI] [PubMed] [Google Scholar]
  • 15. Loef BG, Epema AH, Smilde TD, et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in‐hospital mortality and long‐term survival. J Am Soc Nephrol 2005; 16: 195–200. [DOI] [PubMed] [Google Scholar]
  • 16. Dyke CM, Bhatia D, Aronson S, et al. Perioperative nesiritide and possible renal protection in patients with moderate to severe kidney dysfunction. J Thorac Cardiovasc Surg 2008; 136: 1369–1370. [DOI] [PubMed] [Google Scholar]
  • 17. Chen HH, Sundt TM, Cook DJ, et al. Low dose nesiritide and the preservation of renal function in patients with renal dysfunction undergoing cardiopulmonary‐bypass surgery: a double‐blind placebo‐controlled pilot study. Circulation 2007; 116: 1134–1138. [DOI] [PubMed] [Google Scholar]
  • 18. Aalberts JJ, Boonstra PW, van den Berg MP, et al. In‐hospital mortality and three‐year survival after repaired acute type A aortic dissection. Neth Heart J 2009; 17: 226–231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Tabayashi K, Sai S, Yoshida Y, et al. Thoracic aortic aneurysmectomy with a sutureless intraluminal ringed graft. Cardiovasc Surg 1994; 2: 451–455. [PubMed] [Google Scholar]
  • 20. Edwards FH, Peterson ED, Coombs LP, et al. Prediction of operative mortality after valve replacement surgery. J Am Coll Cardiol 2001; 37: 885–892. [DOI] [PubMed] [Google Scholar]
  • 21. Birkmeyer NJ, Marrin CA, Morton JR, et al; for Northern New England Cardiovascular Disease Study Group. Decreasing mortality for aortic and mitral valve surgery in Northern New England. Ann Thorac Surg 2000; 70: 432–437. [DOI] [PubMed] [Google Scholar]
  • 22. Murday AJ, Hochstitzky A, Mansfield J, et al. A prospective controlled trial of St. Jude versus Starr Edwards aortic and mitral valve prostheses. Ann Thorac Surg 2003; 76: 66–73. [DOI] [PubMed] [Google Scholar]
  • 23. Hueb W, Lopes NH, Gersh BJ, et al. Five‐year follow‐up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized Titcolor controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation. 2007; 115: 1082–1089. [DOI] [PubMed] [Google Scholar]
  • 24. Mangano DT, Miao Y, Vuylsteke A, et al; Investigators of The Multicenter Study of Perioperative Ischemia Research Group, Ischemia Research and Education Foundation. Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery. JAMA 2007; 297: 471–479. [DOI] [PubMed] [Google Scholar]
  • 25. Toumpoulis IK, Chamogeorgakis TP, Angouras DC, et al. Independent predictors for early and long‐term mortality after heart valve surgery. J Heart Valve Dis 2008; 17: 548–556. [PubMed] [Google Scholar]
  • 26. Levy F, Laurent M, Monin JL, et al. Aortic valve replacement for low‐flow/low‐gradient aortic stenosis operative risk stratification and long‐term outcome: a European multicenter study. J Am Coll Cardiol 2008; 51: 1466–1472. [DOI] [PubMed] [Google Scholar]
  • 27. McCullough PA. Cardiorenal risk: an important clinical intersection. Rev Cardiovasc Med 2002; 3: 71–76. [PubMed] [Google Scholar]
  • 28. Ponte B, Felipe C, Muriel A, Tenorio MT, Liaño F. Long‐term functional evolution after an acute kidney injury: a 10‐year study. Nephrol Dial Transplant 2008; 23: 3859–3866. [DOI] [PubMed] [Google Scholar]

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