Impact of Acute Serum Creatinine Elevation in Patients Treated with Nesiritide

Elkayam, Uri; Janmohamed, Munir; Hatamizadeh, Parta; Heywood, J. Thomas; Wei, L. J.; Mills, Roger M.

doi:10.1002/clc.20344

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…112,113 Furthermore, a meta-analysis of data from five randomized controlled trials of nesiritide use in patients with ADHF suggested that nesiritide attenuated the effect of increased serum creatinine level on mortality. 114 Dopamine also has a number of haemodynamic effects and some of these effects vary with the administered dose. The natriuretic effect of dopamine has been known for decades, 115 and dopamine can also act as a vasodilator in the kidneys and increase renal blood flow and GFR.…”

Section: Other Therapies Targeting Haemodynamicsmentioning

confidence: 99%

Cardiorenal syndrome: pathophysiology and potential targets for clinical management

et al. 2012

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Combined dysfunction of the heart and the kidneys, which can be associated with haemodynamic impairment, is classically referred to as cardiorenal syndrome (CRS). Cardiac pump failure with resulting volume retention by the kidneys, once thought to be the major pathophysiologic mechanism of CRS, is now considered to be only a part of a much more complicated phenomenon. Multiple body systems may contribute to the development of this pathologic constellation in an interconnected network of events. These events include heart failure (systolic or diastolic), atherosclerosis and endothelial cell dysfunction, uraemia and kidney failure, neurohormonal dysregulation, anaemia and iron disorders, mineral metabolic derangements including fibroblast growth factor 23, phosphorus and vitamin D disorders, and inflammatory pathways that may lead to malnutrition-inflammation-cachexia complex and protein-energy wasting. Hence, a pathophysiologically and clinically relevant classification of CRS based on the above components would be prudent. With the existing medical knowledge, it is almost impossible to identify where the process has started in any given patient. Rather, the events involved are closely interrelated, so that once the process starts at a particular point, other pathways of the network are potentially activated. Current therapies for CRS as well as ongoing studies are mostly focused on haemodynamic adjustments. The timely targeting of different components of this complex network, which may eventually lead to haemodynamic and vascular compromise and cause refractoriness to conventional treatments, seems necessary. Future studies should focus on interventions targeting these components.

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Section: Other Therapies Targeting Haemodynamicsmentioning

confidence: 99%

Cardiorenal syndrome: pathophysiology and potential targets for clinical management

et al. 2012

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“…The validity of these findings has been questioned since the studies were not designed to evaluate effect on renal function, information regarding concomitant therapy was not available, and data regarding renal function were incomplete. In addition, no relationship could be found between a nesiritide-associated increase in serum creatinine (Ͼ0.5 mg/dL) and 30-day mortality (63). In addition, no relationship could be found between a nesiritide-associated increase in serum creatinine (Ͼ0.5 mg/dL) and 30-day mortality (63).…”

Section: Effect On Renal Functionmentioning

confidence: 94%