Kelesidis Iosif, Mazurek Jeremy A, Saeed Wajeeha, Chaudhari Ronak, Velankar Pradnya, Zolty Ronald
Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Congest Heart Fail. 2012 Jan-Feb;18(1):18-24. doi: 10.1111/j.1751-7133.2011.00273.x. Epub 2011 Nov 27.
Treatment of right ventricular failure (RVF) can be challenging due to the correlation between RVF and worsening renal function with diuretic therapy. Nesiritide has been studied in patients with left ventricular failure but has not been evaluated in isolated RVF. The authors retrospectively analyzed 140 patients admitted with RVF, pulmonary hypertension (PH), and preserved left ventricular systolic function. Seventy patients were treated with nesiritide while the remaining patients received only furosemide (no nesiritide group). Serum creatinine and GFR at baseline, 72 hours, discharge, and 1 month post-treatment, as well as hemodynamic data were compared between the groups. In the nesiritide group, there was a significant decrease in mean GFR (42.77±25.33, P<.001) at day of discharge and 1 month post-nesiritide infusion (41.17±24.94, P<.001) but not in the no nesiritide group. There was a significant difference in >25% decrease in GFR anytime through day 30 (47.14% vs. 25.71%, P=.036) between the two groups. On multivariate analysis, nesiritide remained an important predictor of renal function at discharge and at 1 month (P<.01) as well as a predictor of >25% decrease in GFR anytime through day 30 (P=.007). Thus, nesiritide is associated with worsening kidney function in patients with RVF in the setting of PH.
由于右心室衰竭（RVF）与利尿剂治疗导致的肾功能恶化之间存在关联，RVF的治疗可能具有挑战性。奈西立肽已在左心室衰竭患者中进行了研究，但尚未在孤立的RVF中进行评估。作者回顾性分析了140例因RVF、肺动脉高压（PH）和左心室收缩功能保留而入院的患者。70例患者接受了奈西立肽治疗，其余患者仅接受呋塞米治疗（无奈西立肽组）。比较了两组患者基线、72小时、出院时和治疗后1个月的血清肌酐和肾小球滤过率（GFR）以及血流动力学数据。在奈西立肽组中，出院时平均GFR显著降低（42.77±25.33，P<0.001），奈西立肽输注后1个月时也显著降低（41.17±24.94，P<0.001），而无奈西立肽组则无此现象。两组在第30天内任何时间GFR下降>25%方面存在显著差异（47.14%对25.71%，P=0.036）。多因素分析显示，奈西立肽仍然是出院时和1个月时肾功能的重要预测指标（P<0.01），也是第30天内任何时间GFR下降>25%的预测指标（P=0.007）。因此，在PH背景下，奈西立肽与RVF患者肾功能恶化有关。
