Two drugs do not improve kidney function in acute heart failure patients

November 18, 2013

Two drugs tested in a larger trial did not improve kidney function in acute heart failure patients, contrary to results of smaller studies. The results were presented today at the American Heart Association's Scientific Sessions 2013 in Dallas and simultaneously published in the Journal of the American Medical Association. Previous smaller studies showed that low-dose dopamine or low-dose nesiritide could improve kidney function and reduce fluid overload that is often present in hospitalized acute heart failure patients by increasing urine production.

In the Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF) randomized 26-site trial in the U.S. and Canada, researchers analyzed data on 360 hospitalized acute heart failure with kidney dysfunction from September 2010 to March 2013. Compared to placebo, researchers found that neither dopamine nor nesiritide, when also used with diuretic (water pills) therapy, was better at increasing urine volume or improving levels of serum cystatin-C, an indicator of , at the end of a 72-hour treatment.

"Kidney-enhancing therapies in acute heart failure continue to elude us," says Horng Chen, M.B., B.Ch., lead author and Mayo Clinic cardiologist. "In the past five years, all the major acute heart failure therapeutic clinical trials 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."

Therefore, one take-away from the results of ROSE-AHF is that future studies in acute heart failure may need to target specific subgroups of these patients. For example, some patients have preserved ejection fraction, where the heart's lower chambers are stiff and cannot relax enough to fill fully between beats, and others may have reduced , where the heart is weak, Dr. Chen says.

Heart failure occurs when the heart doesn't pump blood as well as it should. Acute heart failure—when require hospitalization—is the most common cause of hospitalization in patients 65 years and older in the U.S., according to the American Heart Association.

"The study shows that as a one-size-fits-all therapy for patients with renal dysfunction, neither dopamine nor nesiritide improved the ability to get rid of excess fluid while protecting the kidneys in patients hospitalized for heart failure," says senior author Margaret Redfield, M.D., Mayo Clinic cardiologist. "The ROSE-AHF study suggests that these two drugs may have different effects in different types of heart failure. Future studies need to carefully assess the effect of therapies in specific types of patients as drugs may help some patients and not others."

Explore further: RELAX-AHF shows first positive findings in HFpEF patients

More information: doi:10.l001/jama.2013.282190

Related Stories

RELAX-AHF shows first positive findings in HFpEF patients

May 26, 2013
Serelaxin may be more effective for relieving dyspnea in heart failure with preserved ejection fraction (HFpEF) than reduced (HFrEF) during the first 24 hours, according to results from RELAX-AHF presented in today's late ...

New study shows spironolactone reduces heart failure hospitalizations, but not mortality

November 18, 2013
A late-breaking clinical trial, known as the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, to be presented at the American Heart Association (AHA) Scientific Sessions, ...

Patients with heart failure need specialist care

November 1, 2013
(Medical Xpress)—New research from Karolinska Institutet in Sweden shows that patients with heart failure have high mortality and often are undertreated. According to a study, published in the scientific periodical JACC, ...

Ultrafiltration may not be best approach for heart failure patients, research finds

November 7, 2012
Ultrafiltration was no more effective in removing excess fluid from the heart than using standard treatment including diuretics to reduce congestion in heart failure patients, according to late-breaking clinical trial research ...

Heart failure patients living longer, but long-term survival still low

May 16, 2013
People hospitalized for acute heart failure are likely to survive longer compared to the prior decade, according to a new study in the Journal of the American Heart Association and presented at the American Heart Association's ...

Living better with heart failure by changing what you eat

September 24, 2013
Diet can dramatically lower hypertension and improve heart function in patients with a common type of heart failure, according to research presented at today's Heart Failure Society of America meeting in Orlando, Fla.

Recommended for you

Could this protein protect people against coronary artery disease?

November 17, 2017
The buildup of plaque in the heart's arteries is an unfortunate part of aging. But by studying the genetic makeup of people who maintain clear arteries into old age, researchers led by UNC's Jonathan Schisler, PhD, have identified ...

Raising 'good' cholesterol fails to protect against heart disease

November 16, 2017
Raising so-called 'good' cholesterol by blocking a key protein involved in its metabolism does not protect against heart disease or stroke, according to a large genetic study of 150,000 Chinese adults published in the journal ...

New model estimates odds of events that trigger sudden cardiac death

November 16, 2017
A new computational model of heart tissue allows researchers to estimate the probability of rare heartbeat irregularities that can cause sudden cardiac death. The model, developed by Mark Walker and colleagues from Johns ...

Popular e-cigarette liquid flavorings may change, damage heart muscle cells

November 16, 2017
Chemicals used to make some popular e-cigarette liquid flavorings—including cinnamon, clove, citrus and floral—may cause changes or damage to heart muscle cells, new research indicates.

Possible use for botulinum toxin to treat atrial fibrillation

November 16, 2017
From temporarily softening wrinkles to easing migraines, botulinum toxin has become a versatile medical remedy because of its ability to block nerve signals that can become bothersome or risky.

Proteome of the human heart mapped for the first time

November 15, 2017
A healthy heart beats about two billion times during a lifetime, thanks to the interplay of more than 10,000 proteins. Researchers from the Max Planck Institute of Biochemistry (MPIB) and the German Heart Centre at the Technical ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.