Effects of intravenous nesiritide on renal hemodynamics in patients with congestive heart failure

Abstract

Objectives: To evaluate the renal circulatory effects of intravenous nesiritide in patients with congestive heart failure (CHF). Background: Nesiritide, recombinant human B-type natriuretic peptide, has been shown to be efficacious in the treatment of decompensated heart failure and to improve renal function. The exact mechanism of nesiritide effect on the kidney and renal circulation in patients with CHF has not been fully investigated. Methods: Thirteen patients with CHF underwent cardiac catheterization and measurements of renal blood flow using quantitative renal artery angiography and intra renal arterial Doppler flow velocity at baseline, after nesiritide bolus injection (2μ/kg) and 15 minutes after initiation of continuous nesiritide infusion (0.01μ/kg/min). Results: Fifteen minutes of continuous nesiritide infusion resulted in 13% reduction in mean right atrial pressure (p=0.16), 15% in mean pulmonary artery pressure (p<0.005) and 30% in mean pulmonary capillary wedge pressure (p<0.005). Changes in renal hemodynamics were as follows: (please see table). Conclusions: Nesiritide exerts a renal vasodilatory effect predominantly on the large conductance vessels. Renal blood flow is increased after bolus nesiritide administration and is maintained during nesiritide continous infusion in spite of a significant decrease in renal perfusion pressure.∗Changes in renal hemodynamics post nesiritide bolus and during a 15 minutes nesiritide infusion compared to baselineMean Renal Artery Pressure (mmHg)Renal Artery Diameter (mm)Average Renal Peak Velocity (m/s)Renal Blood Flow (ml/min)Baseline99±176.24±0.729±16269±164Bolus93±156.36±0.832±18316±213∗Infusion89±12∗6.73±0.8∗∗24±16∗262±189†∗p<0.05 vs baseline∗∗p<0.0005 vs baseline†p=0.02 vs bolus