Cheng Judy W M, Merl Man Yee, Nguyen Huan M
Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY 10029, USA.
Curr Med Res Opin. 2005 Nov;21(11):1857-63. doi: 10.1185/030079905X65240.
Recent meta-analysis has demonstrated that nesiritide may worsen renal function (RF) in patients with acute decompensated heart failure (ADHF). A nesiritide utilization evaluation (NUE) performed in our institution reflected that belief of RF preservation was one reason leading to nesiritide overuse. This study examined the effect of nesiritide on RF in patients evaluated in this NUE.
Nesiritide patient records from October 1, 2003 to March 31, 2004 were reviewed (n = 162). Pertinent demographics, laboratory and medication utilization data were obtained.
Changes in creatinine clearance (CrCl) and percentage of patients demonstrating worsening RF (decrease in CrCl > or = 25%) during diuretics therapy before nesiritide initiation and during nesiritide initiation and during nesiritide therapy were compared using Wilcoxon Signed-Ranks test and Chi-Square respectively.
Overall, the addition of nesiritide to IV furosemide did not clinically change RF as compared to the use of IV furosemide alone (% change in CrCl: 0 vs. -2.13 mL/min, p = 0.023), although the difference was statistically significant. When categorized into different RF, there is no different in CrCl changes between the nesiritide group and the IV furosemide alone group. There is also no difference in terms of number of patients experiencing > or = 25% reduction in CrCl overall. Changes in RF were also not correlated to dose or duration of therapy.
Nesiritide did not demonstrate significant impact in RF. Larger studies that examine RF in a more systematic and controlled manner and relate changes in RF to clinical outcomes are necessary to further elucidate the risk versus benefit profile of nesiritide.
近期的荟萃分析表明，奈西立肽可能会使急性失代偿性心力衰竭（ADHF）患者的肾功能（RF）恶化。在我们机构进行的一项奈西立肽使用评估（NUE）显示，认为其能保护肾功能是导致奈西立肽过度使用的原因之一。本研究调查了在该NUE中接受评估的患者使用奈西立肽对肾功能的影响。
回顾了2003年10月1日至2004年3月31日期间使用奈西立肽的患者记录（n = 162）。获取了相关的人口统计学、实验室和药物使用数据。
分别使用Wilcoxon符号秩检验和卡方检验，比较在开始使用奈西立肽前的利尿剂治疗期间、开始使用奈西立肽期间以及使用奈西立肽治疗期间，肌酐清除率（CrCl）的变化以及肾功能恶化（CrCl降低≥25%）的患者百分比。
总体而言，与单独使用静脉注射速尿相比，在静脉注射速尿中添加奈西立肽在临床上并未改变肾功能（CrCl的变化百分比：0对-2.13 mL/分钟，p = 0.023），尽管差异具有统计学意义。当按不同肾功能进行分类时，奈西立肽组和单独使用静脉注射速尿组之间的CrCl变化并无差异。在CrCl总体降低≥25%的患者数量方面也没有差异。肾功能的变化也与治疗剂量或持续时间无关。
奈西立肽对肾功能未显示出显著影响。需要进行更大规模的研究，以更系统和可控的方式检查肾功能，并将肾功能变化与临床结果相关联，以进一步阐明奈西立肽的风险与获益情况。
