Effects of Perioperative Nesiritide in Patients With Left Ventricular Dysfunction Undergoing Cardiac Surgery

Mentzer, Robert M.; Öz, Mehmet C.; Sladen, Robert N.; Graeve, Allen; Hebeler, Robert F.; Luber, John M.; Smedira, Nicholas G.; Investigators, Napa

doi:10.1016/j.jacc.2006.10.048

Cited by 263 publications

(175 citation statements)

References 33 publications

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“…Nesiritide, the recombinant human BNP, has been shown to be beneficial according to initial results. Further studies are required before applying nesiritide routinely in daily clinical practice [182,183] . N-Acetylcysteine has protective effects on contrastinduced nephropathy [184] .…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

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Serum creatinine is still the most important determinant in the assessment of perioperative renal function and in the prediction of adverse outcome in cardiac surgery. Many biomarkers have been studied to date; still, there is no surrogate for serum creatinine measurement in clinical practice because it is feasible and inexpensive. High levels of serum creatinine and its equivalents have been the most important preoperative risk factor for postoperative renal injury. Moreover, creatinine is the mainstay in predicting risk models and risk factor reduction has enhanced its importance in outcome prediction. The future perspective is the development of new definitions and novel tools for the early diagnosis of acute kidney injury largely based on serum creatinine and a panel of novel biomarkers.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

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“…9 Renoprotection was also evident in patients with moderate to severe renal dysfunction undergoing cardiopulmonary-bypass CV surgery. 16,17 These short-and intermediate-term observations are in accordance with those observed in the Nesiritide Study.…”

Section: Discussionmentioning

confidence: 98%

“…Postoperative GFR was calculated using the MDRD GFR calculator, and is in accordance with previous published reports. 9,10 …”

Section: Study Protocol For the Nesiritide Studymentioning

confidence: 99%

Long‐term Outcome of Patients Treated With Prophylactic Nesiritide for the Prevention of Acute Kidney Injury Following Cardiovascular Surgery

Lingegowda¹,

Van²,

Shimada³

et al. 2010

Clinical Cardiology

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Background: Previously, we reported that the prophylactic use of nesiritide did not reduce the incidence of dialysis or death following cardiovascular (CV) surgery despite reducing the incidence of acute kidney injury (AKI) in the immediate postoperative period. Therefore, we investigated whether the observed renal benefits of nesiritide had any long-term impact on cumulative patient survival and renal outcomes. Methods: Participants of the Nesiritide Study, a previously reported prospective, double-blind, placebocontrolled, randomized clinical trial investigating the effect of nesiritide on the incidence of dialysis or death at 21 days in adult patients undergoing high-risk CV surgery, were included in the study. Data of the participants' most recent health and renal function status were obtained using institutional review board-approved patient questionnaires, medical records, and the database of the Social Security Administration. Results: Data on all 94 patients from the Nesiritide Study were obtained. The mean follow-up period was 20.8 ± 10.4 months. No differences in cumulative survival between the groups were noted at follow-up (nesiritide 77.7% vs placebo 81.6%, P = 0.798). Patients with in-hospital incidence of AKI had a higher rate of mortality than those with no AKI (AKI 41.4% vs no AKI 10.7%, P = 0.002). However, differences in survival time were not significant between the groups when the analysis was restricted to patients with AKI (nesiritide 16.8 ± 4 months vs placebo 18.5 ± 2.3 months, P = 0.729). Conclusions: Renoprotection provided by nesiritide in the immediate postoperative period was not associated with improved long-term survival in patients undergoing high-risk CV surgery. IntroductionEvidence for the renoprotective effect of natriuretic peptides in clinical settings remains controversial. 1 -4 Previously, we reported in a retrospective study that the use of the B-type natriuretic peptide (BNP) nesiritide (Natrecor) in patients with impaired renal function (serum creatinine [SCr]>1 mg/dL) who were undergoing cardiovascular (CV) surgery was associated with a dramatic reduction in 21-day dialysis-free survival (odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.14-0.87, P = 0.024). 5 However, in a follow-up prospective, randomized clinical trial (the Nesiritide Study), we could not demonstrate a benefit for prophylactic use of nesiritide as related to the incidence of 21-day dialysis and/or death in patients undergoing high-risk CV surgery (nesiritide 6.6% vs control 6.1%; P = 0.914). 6 The study did demonstrate that the prophylactic use of nesiritide was associated with reduced incidence

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“…In human studies, diuretics and low dose dopamine have long been discredited, 22 and although meta-analyses suggest that the selective dopamine-1 agonist, fenoldopam, may be protective, 23,24 the definitive prospective studies have not been done. Nesiritide, human recombinant B-type natriuretic peptide, demonstrated renal protection in one cardiac surgical study 25 that has never been followed up. N-acetylcysteine was heralded as a renal protective agent in radiocontrast nephropathy, 26 but it does not appear to be effective in settings of ischemia-reperfusion injury such as cardiac surgery.…”

Section: Ormentioning

confidence: 99%

Acute kidney injury: We’ve got the diagnosis, now what?

Sladen

2012

Can J Anesth/J Can Anesth

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Effects of Perioperative Nesiritide in Patients With Left Ventricular Dysfunction Undergoing Cardiac Surgery

Abstract: Nesiritide in the setting of CABG with CPB is associated with improved postoperative renal function and possibly enhanced survival. (The NAPA Trial; ; ).

Cited by 263 publications

References 33 publications

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Long‐term Outcome of Patients Treated With Prophylactic Nesiritide for the Prevention of Acute Kidney Injury Following Cardiovascular Surgery

Acute kidney injury: We’ve got the diagnosis, now what?

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