Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-09T14:21:18.798Z Has data issue: false hasContentIssue false
  • English
  • Français

The use of nesiritide in patients with critical cardiac disease

Published online by Cambridge University Press:  23 June 2017

Ronald A. Bronicki ,
Michele Domico ,
Paul A. Checchia ,
Curtis E. Kennedy  and
Ayse Akcan-Arikan
Ronald A. Bronicki*
Affiliation:
Section of Pediatric Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Michele Domico
Affiliation:
Section of Pediatric Critical Care Medicine, Children’s Hospital of Orange County, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
Paul A. Checchia
Affiliation:
Section of Pediatric Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Curtis E. Kennedy
Affiliation:
Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Ayse Akcan-Arikan
Affiliation:
Section of Pediatric Critical Care Medicine and Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
*
Correspondence to: R. A. Bronicki, MD, Section of Pediatric Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children’s Hospital, W6006, 6621 Fannin Street, Houston, TX 77030, United States of America. Tel: 832 826 6214, Fax: +832 825 7422, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

We evaluated the use of nesiritide in children with critical CHD, pulmonary congestion, and inadequate urine output despite undergoing conventional diuretic therapy.

Design

We conducted a retrospective analysis of 11 patients with critical CHD, comprising 18 infusions, each of which occurred during separate hospitalisations. Haemodynamic parameters were assessed, and the stage of acute kidney injury was determined before and throughout the duration of therapy using a standardised definition of acute kidney injury – The Kidney Disease: Improving Global Outcomes criteria.

Patients

Children with critical CHD, pulmonary congestion, and inadequate urinary output despite undergoing diuretic therapy were included.

Measurements and main results

The use of nesiritide was associated with a significant decrease in the maximum and minimum heart rate values and with a trend towards a significant decrease in maximum systolic blood pressure and maximum and minimum central venous pressures. Urine output increased but was not significant. Serum creatinine levels decreased significantly during the course of therapy (−0.26 mg/dl [−0.50, 0.0], p=0.02), and the number of patients who experienced a decrease in the stage of acute kidney injury of 2 or more – where a change in the stage of acute kidney disease of 2 or more was possible, that is, baseline stage >1 – was highly significant (five of 12 patients, 42%, p<0.001).

Conclusions

Nesiritide had a favourable impact on haemodynamics, and its use was not associated with deterioration of renal function in patients with critical CHD.

Keywords

Nesiritide, CHDsingle-ventricle physiologyacute kidney injury
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1577 - 1584
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Colucci, WS, Elkayam, U, Horton, DP, et al. Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. New Engl J Med 2000; 343: 246–253.Google Scholar
2. Charloux, A, Piquard, F, Doutreleau, S, et al. Mechanisms of renal hyporesponsiveness to ANP in heart failure. Eur J Clin Invest 2003; 33: 769–778.Google Scholar
3. Liang, F, O’Rear, J, Schellenberger, U, et al. Evidence for functional heterogeneity of circulating B-type natriuretic peptide. J Am Coll Cardiol 2007; 49: 1071–1078.Google Scholar
4. Sackner-Bernstein, JD, Skopicki, HA, Aaronson, KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation 2005; 111: 1487–1491.Google Scholar
5. van Deursen, VM, Hernandez, AF, Stebbins, A, et al. Nesiritide, renal function, and associated outcomes during hospitalization for acute decompensated heart failure. Results from the Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure (ASCEND-HF). Circulation 2014; 130: 958–965.Google Scholar
6. Jefferies, JL, Denfield, SW, Price, JF, et al. A prospective evaluation of nesiritide in the treatment of pediatric heart failure. Pediatr Cardiol 2006; 27: 402–407.CrossRefGoogle ScholarPubMed
7. Jefferies, JL, Price, JF, Denfield, SW, et al. Safety and efficacy of nesiritide in pediatric heart failure. J Cardiac Fail 2007; 13: 541–548.Google Scholar
8. Simsic, JM, Mahle, WT, Cuadrado, A, et al. Hemodynamic effects and safety of nesiritide in neonates with heart failure. J Intensive Care Med 2008; 23: 389–395.Google Scholar
9. Simsic, JM, Scheurer, M, Tobias, JD, et al. Perioperative effects and safety of nesiritide following cardiac surgery in children. J Intensive Care Med 2006; 21: 22–26.Google Scholar
10. Mahle, WT, Cuadrado, AR, Kirshbom, PM, et al. Nesiritide in infants and children with congestive heart failure. Pediatr Crit Care Med 2005; 6: 543–546.Google Scholar
11. Kellum, JA, Lameire, N; KDIGO AKI guideline work group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013; 17: 204.Google Scholar
12. Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.Google Scholar
13. Boer, DP, de Rijke, YB, Hop, WC, et al. Reference values for serum creatinine in children younger than 1 year of age. Pediatr Nephrol 2010; 25: 2107–2113.Google Scholar
14. Mishra, J, Dent, C, Tarabishi, R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365: 1231–1238.Google Scholar
15. Waikar, SS, Bonventre, JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009; 20: 672–679.Google Scholar
16. Akcan-Arikan, A, Zappitelli, M, Loftis, LL, et al. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007; 71: 1028–1035.Google Scholar
17. Selewski, DT, Cornell, TT, Heung, M, et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 2014; 40: 1481–148816.Google Scholar
18. Medar, SS, Hsu, DT, Lamour, JM, et al. Acute kidney injury in pediatric acute decompensated heart failure. Pediatr Crit Care Med 2015; 16: 535–541.Google Scholar
19. Sanchez-Pinto, LN, Goldstein, S, Scheider, J, et al. Improvement of acute kidney injury and mortality in critically ill children. Pediatr Crit Care Med 2015; 16: 703–710.Google Scholar
20. Lex, DJ, Toth, R, Cserep, Z, et al. A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. Ann Thorac Surg 2014; 97: 202–210.Google Scholar
21. Migliavacca, F, Pennati, G, Dubini, G, et al. Modeling of the Norwood circulation: effects of shunt size, vascular resistances, and heart rate. Am J Heart Circ Physiol 2001; 280: H2076–H2086.Google Scholar
22. Hoffman, GM, Tweddell, JS, Ghanayem, NS, et al. Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the Norwood procedure. J Thorac Cardiovasc Surg 2004; 127: 738–745.Google Scholar
23. Li, J, Zhang, G, McCrindle, BW, et al. Profiles of hemodynamics and oxygen transport derived by using continuous measured oxygen consumption after the Norwood procedure. J Thorac Cardiovasc Surg 2007; 133: 441–448.Google Scholar
24. Dunn, BR, Ichikawa, I, Pfeffer, JM, et al. Renal and systemic hemodynamic effects of synthetic atrial natriuretic peptide in the anesthetized rat. Circ Res 1986; 59: 237–246.Google Scholar
25. Maack, T, Atlas, SA, Camargo, MJ, et al. Renal hemodynamic and natriuretic effects of atrial natriuretic factor. Fed Proc 1986; 45: 2128–2132.Google Scholar
26. Jentzer, JC, DeWald, TA, Hernandez, AF. Combination of loop diuretics with thiazide-type diuretics in heart failure. J Am Coll Cardiol 2010; 56: 1527–1534.Google Scholar
27. Costello, JM, Dunbar-Masterson, C, Allan, CK, et al. Impact of empiric nesiritide or milrinone infusion on early postoperative recovery after Fontan Surgery. A randomized, double-blind, placebo-controlled trial. Cir Heat Fail 2014; 7: 596–604.Google Scholar
28. Newton, G, Parker, J. Cardiac sympathetic responses to acute vasodilation. Circulation 1996; 94: 3161–3167.Google Scholar
29. Brunner-La Rocca, H, Kaye, D, Woods, R, et al. Effects of intravenous brain natriuretic peptide on regional sympathetic activity in patients with chronic heart failure as compared with healthy control subjects. J Am Coll Cardiol 2100; 37: 1221–1227.Google Scholar