Brain Natriuretic Peptide (BNP) to Preserve Renal Function in Hospitalized Patients With Heart Failure
Status:
Completed
Trial end date:
2008-07-01
Target enrollment:
Participant gender:
Summary
Patients hospitalized for treatment of decompensated heart failure (CHF) are at risk for
prolonged length of stay (LOS) and frequent readmissions. Renal dysfunction and diuretic
resistance contribute to this risk, particularly if renal dysfunction worsens during CHF
treatment. Brain natriuretic peptide (BNP) is a hormone of myocardial cell origin with
well-defined physiological effects which include arterial and venous vasodilation,
suppression of adverse neurohumoral systems and favorable effects on renal hemodynamics and
sodium excretion. Recombinant human BNP (Natrecor) is approved by the FDA for treatment of
decompensated CHF as it has been demonstrated to lower filling pressures and improve
symptoms. While clinical trials and the FDA support the use of BNP as adjuvant therapy in
decompensated CHF, the extent of its efficacy in improving non-hemodynamic CHF parameters has
not been fully defined.
The objective of this clinical practice protocol is to determine whether use of BNP in
addition to standard therapy, will preserve renal function and facilitate diuresis in
patients with CHF and mild-moderate renal impairment (creatinine clearance > 20 but < 60
ml/min) as compared to standard therapy alone. Patients admitted to the Mayo Heart Failure
Service who meet entrance criteria will be randomized to standard clinical practice with or
without a 48 hour infusion of BNP.
The primary endpoints will be indices of renal function and diuretic response at 1, 2 and 3
days and at discharge. Secondary endpoints will be neurohumoral function, LOS and 30-day
readmission rate.