Patients with acute heart failure and kidney impairment do not benefit from either low-dose dopamine or low-dose nesiritide, according to a study published online Nov. 18 in JAMA and presented simultaneously at the American Heart Association’s scientific session in Dallas.
“Small studies suggest that low-dose dopamine or low-dose nesiritide may enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction; however, neither strategy has been rigorously tested,” wrote the investigators, led by Horng H. Chen, MBBCh, of the Mayo Clinic in Rochester, Minn.
The Renal Optimization Strategies Evaluation (ROSE) trial randomized 360 hospitalized patients with acute heart failure and renal dysfunction (defined by an estimated glomerular filtration of 15 to 60 ml/min/1.73 m 2) from 26 sites in North America between 2010 and 2013 to receive either dopamine, nesiritide (Natrecor, Scios) or placebo. All participants received intravenous loop diuretics seven days before hospital admission. The primary endpoints were 72-hour urine volume and the change in serum cystatin C over 72 hours.
Neither dopamine nor nesiritide significantly affected urine volume when compared to placebo or the change in cystatin C concentration. The difference in urine output between the dopamine and placebo groups was 229 ml, with dopamine output slightly higher. The difference in urine output between nesiritide and placebo was 279 ml, with nesiritide slightly higher). The cystatin level for the dopamine group was 0.12 mg/L compared with 0.11 mg/L. For nesiritide, the level was 0.07 mg/L vs. 0.11 mg/L for placebo.
The secondary outcomes—reflecting decongestion, kidney function or clinical outcomes—were also not affected by either drug.
The findings do not match up with results from other studies, but the authors noted that the participants or methodologies differed.
The researchers also acknowledged that their study was not able to determine differences in clinical events. Additionally, some participants took diuretics before being randomized or had their diuretic doses adjusted after the first day, which could have skewed the primary endpoint data.