Dopamine and Nesiritide Disappoint in Acute HF with Renal Dysfunction

Findings from small physiological studies suggest that both low-dose dopamine and B-type natriuretic peptide (BNP) may enhance urine output in patients with acute heart failure (HF) and impaired kidney function without further adverse renal effects. In a trial sponsored by the National Heart, Lung, and Blood Institute, investigators compared low-dose dopamine, low-dose nesiritide (a recombinant BNP), and placebo in 360 patients with acute decompensated HF and concomitant renal dysfunction (median age, 70; 73% men; 26% with preserved ejection fraction; estimated glomerular filtration rate, 15–60 mL/min/1.72 m²).

Patients were randomized first 1:1 to dopamine or nesiritide, then 2:1 to treatment (dopamine, 2 µg/kg/min; nesiritide, 0.005 µg/kg/…