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The use of nesiritide, a synthetic natriuretic peptide, for treating acute decompensated heart failure declined substantially after the publication of meta-analyses suggesting that the drug may worsen renal function and possibly increase the risk for death (Journal Watch Cardiology May 6 2005). However, no prospective studies of nesiritide’s impact on renal function have been conducted. In this manufacturer-sponsored, two-center trial, 75 patients (mean age, 75) with acute decompensated heart failure (preserved systolic function, 42%) and moderate renal impairment were randomized to receive nesiritide (bolus dose at the discretion of the treating physician, followed by a 48-hour continuous infusion) or placebo.
The incidence of worsening ren…