Does Nesiritide Increase Risks for Renal Failure and Death?

Nesiritide, an intravenously administered B-type natriuretic peptide with potent vasodilator properties, is used widely to manage acute decompensated heart failure (HF). However, two new meta-analyses raise the possibility of risks associated with nesiritide in this patient population.

In one meta-analysis, investigators analyzed data from five published randomized trials (involving 1269 patients) in which the effects of nesiritide on renal function were assessed. The overall rate of in-hospital worsening renal function, defined as a rise in serum-creatinine level by >0.5mg/dL, was 21% among recipients of nesiritide (≤0.06 μg/kg/minute) and 15% among recipients of control therapies (relative risk, 1.54; P=0.001). The findings were consistent…