Dopamine and nesiritide do not help acute HF patients

Study highlights need for kidney-enhancing therapy

LOW-DOSE dopamine and low-dose nesiritide treatment were recently found unable to improve kidney function in acute heart failure (AHF) patients despite claims in earlier studies that the two drugs work, according to the Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF) presented at the American Heart Association’s Scientific Sessions 2013 in Dallas.

The study, which was simultaneously published in the Journal of American Medical Association, was a randomized trial in 26 US and Canadian sites. The researchers examined data from 360 hospitalized ACF patients with kidney dysfunction from September 2010 to March 2013.

The study compared the results of the two drugs with diuretic therapy to placebo and concluded that neither drug was better at increasing urine volume or improving levels of serum cystatin-C at the end of the 72-hour treatment.

“Kidney-enhancing therapies in acute heart failure continue to elude us. In the past five years, all the major acute heart failure therapeutic clinical trial have not demonstrated beneficial effects of the therapies tested. This could be partly because the definition of acute heart failure is broad, and hence it includes a diverse group of patients,” said Dr. Horng Chen, M. B., lead author of the study and Mayo Clinic cardiologist, alluding to the need to conduct future studies in acute heart failure targeted at specific sub groups.

Dr. Chen further explained that some patients have preserved ejection fraction where the heart’s lower chambers are stiff and cannot relax enough to fill fully between beats, and other may have reduced ejection fraction where the heart is weak.

“The study shows that as a one size-fits-all therapy for acute heart failure patients with renal dysfunction, both dopamine and nesiritide do not improve the ability to get rid of excess fluid for heart failure,” says fellow Mayo Clinic cardiologist and senior author Margaret Redfield, MD.

“The ROSE-AHF study suggests that these two drugs may have different effects in different types of heart failure. Future heart failure studies need to careful assess the effect of therapies in specific types of patients as drugs may help some patients and not others.” Michaela Sarah De Leon with a JAMA report

VitalSigns Issue 58 Vol. 2, December 1-31, 2013