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In ASCEND-HF, 7141 patients hospitalized with ADHF were randomized to receive either nesiritide or placebo for 24 to 168 hours in addition to standard care. As previously reported, there were minimal effects of nesiritide on survival, future hospitalizations, and symptoms. However, the question has remained as to whether nesiritide increases diuresis in patients with CHF.
Urine output was measured in 5864 subjects. 5320 received loop diuretics (72% intravenous) and had dose data recorded. For this analysis, loop diuretics other than furosemide were converted to “furosemide equivalent doses”. Using logistic regression models, we identified (in 4881 patients with complete data) the impact of nesiritide on urine output and the factors associated with high urine output.
Mean 24 hr urine output was 2565 ± 1381 ml with nesiritide & 2512 ± 1347 with placebo (p=NS). Mean loop diuretic dose (furosemide equivalent) was 109 ± 122 mg with nesiritide and 110 ± 127 mg with placebo. Diuretic dose was the strongest predictor of urine output. Also independently predictive of more urine output were male sex, greater BMI, higher diastolic blood pressure, elevated jugular venous pressure, recent weight gain, and lower BUN. Addition of nesiritide to this multivariate model did not change urine output. We looked at interaction terms between nesiritide and predictors of urine output to define any subgroup that might benefits with nesiritide. None of these interaction terms affected the prediction of the urine output.
In ASCEND-HF, nesiritide did not increase urine output in patients with acute decompensated heart failure. Higher diuretic dose was the strongest predictor of higher urine output, but neurohormonal activation (as evidenced by BUN concentration) and lower blood pressure limited diuresis.
Oral Contributions South, Room 102
Saturday, March 09, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Heart Failure Pathogenesis and Therapy
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 905-4
- 2013 American College of Cardiology Foundation