Nesiritide and Renal Dysfunction — Another Drop in the Bucket?

Nesiritide, a systemic and pulmonary vasodilator, has been used widely to treat acute decompensated heart failure. In 2005, a meta-analysis demonstrated worsened renal function with nesiritide treatment, which led to an extensive decline in clinical use. In a prospective, randomized, double-blind, placebo-controlled industry-funded trial, researchers evaluated the effect of nesiritide on renal function in patients with moderate renal dysfunction who required treatment for acute decompensated heart failure.

Of 514 consecutive patients with acute decompensated heart failure who presented to two California hospitals during a 2-year period, 75 patients had moderate renal dysfunction (glomerular filtration rate of 15–60 mL/minute) and met inclusi…