Renal Effects of Combination Infusion of High Dose Furosemide and Nesiritide in Patients with Acutely Decompensated Heart Failure

Abstract

Background: Limited and conflicting data exist on renal effects of combined therapy with Furosemide and Nesiritide infusions in pts with acute decompensated heart falure (ADHF). Methods: We examined data on 45 consecutive pts who were admitted with ADHF who received combination Nesiritide infusion at 0.01 mcg/kg/min and Furosemide infusion at 5–10 mg/hr for at least 12 hrs. Pts with stage V chronic kidney disease or on dialysis as well as patients who received the combination treatment post-cardiac surgery were excluded. Data were reviewed retrospectively. Results: Out of 45 patients, 20 (44.4%) were female and 40 (89%) were black. Average age was 54.4 years (17). Mean EF was 19% (11). Most patients (84%) had some degree of renal dysfunction on admission, ranging from mildly to severely reduced glomerular filtration rate (GFR). Average time on combination therapy was 34 hours (±15). During combination treatment,mean diuresis was 4547 ml (±2976) and average wt loss was 9.4 lbs (±8.5). Mean BUN was 22(±9)mg/dl on admission and 26 mg/dl (±13)mg/dl upon discharge (p=0.01). Mean creatinine of was 1.3 mg/dl (±0.4) mg/dl on admission and 1.4 (±0.5) mg/dl upon discharge (p=0.36). Mean GFR was 62 (±22) ml/min/m2 on admission and 59 (±24) ml/min/m2upon discharge (p=0.17). Only 4 pts (9%) experienced worsening renal function (WRF) as defined by increase in serum creatinine of >0.5 mg/dl between admission and discharge or increase in serum creatinine of >0.3 mg/dl during the hospitalization to a level >1.5 mg/dl at discharge. None of the pts required acute dialysis during the index hospitalization and the highest degree of creatinine elevation was 0.8 mg/dl from baseline. There were no deaths during the index hospitalization.Figure 1: Difference in Creatinine Values (mg/dl) of the 45 Patients Between Admission and DischargeConclusion: Combined therapy of continous high dose Furosemide and Nesiritide infusions is not associated with WRF, and the degree of creatinine elevation is generally mild. The combination therapy is effective and useful in achieving large volume diuresis with minimal renal consequences.