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. 2006 Dec 5;29(1):18–24. doi: 10.1002/clc.4960290106

Effectiveness of nesiritide on dialysis or all‐cause mortality in patients undergoing cardiothoracic surgery

Thomas M Beaver 1,✉, Almut G Winterstein 2, Jonathan J Shuster 3, Tobias Gerhard 2, Tomas Martin 1, James A Alexander 1, Richard J Johnson 4, Ahsan Ejaz 4, Abraham G Hartzema 1
PMCID: PMC6653871  PMID: 16477773

Abstract

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 serumcreatinine 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.

Keywords: kidney disease, heart disease, pharmacology/clinical, surgery adult/aortic disease, surgery adult/coronary artery, surgery adult/valvular

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