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J Thorac Cardiovasc Surg 2008;136:1369-1370
© 2008 The American Association for Thoracic Surgery

Brief Communicaion

Perioperative nesiritide and possible renal protection in patients with moderate to severe kidney dysfunction

Cornelius McKown Dyke, MDa,*, Devinder Bhatia, MDb, Solomon Aronson, MDc, Nader Moazami, MDd, Robert M. Mentzer, Jr., MDe

a Gaston Memorial Hospital, Gastonia, NC
b Southeast Texas Cardiovascular, Houston, Tex
c Duke University School of Medicine, Durham, NC
d Washington University School of Medicine, St Louis, Mo
e Wayne State School of Medicine, Detroit, Mich

Received for publication October 15, 2007; accepted for publication December 2, 2007.

* Address for reprints: Cornelius McKown Dyke, MD, Gaston Memorial Hospital, 2555 Court Dr, Suite 200, Gastonia, NC 28056.

The first 20% of the full text of this article appears below.

Postoperative renal dysfunction develops in approximately 5% to 30% of patients undergoing cardiac surgery with cardiopulmonary bypass, is a potent predictor of poor outcomes, and is especially prevalent among patients with preexisting renal dysfunction.1,2Go Strategies to protect kidney function during cardiac surgery have included the use of low-dose dopamine, fenoldopam mesylate (INN fenoldopam), bicarbonate infusion, and diuretics, yet efficacy of any treatment has been difficult to demonstrate.

Nesiritide, a recombinant form of human B-type natriuretic peptide, has been suggested to be renally protective for patients with end-stage heart failure.3Go Additionally, in the exploratory Nesiritide Administered Peri-Anesthesia (NAPA) trial, patients with congestive heart failure undergoing cardiac surgery who received nesiritide had a significantly lower incidence of postoperative renal dysfunction.4Go The goal of this post hoc evaluation of the NAPA trial was to assess the impact of perioperative nesiritide on patients with preexisting, non–hemodialysis dependent, moderate-to-severe renal dysfunction.

Materials and Methods

The design and methodology of the NAPA trial has been reported previously.4Go In brief, patients with chronic left ventricular dysfunction underwent cardiac surgery utilizing cardiopulmonary bypass. Patients were randomly assigned to . . . [Full Text of this Article]






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