scholarly journals Maximizing the Renal Cyclic 3′-5′-Guanosine Monophosphate System with Type V Phosphodiesterase Inhibition and Exogenous Natriuretic Peptide: A Novel Strategy to Improve Renal Function in Experimental Overt Heart Failure

2006 ◽  
Vol 17 (10) ◽  
pp. 2742-2747 ◽  
Author(s):  
Horng H. Chen ◽  
Brenda K. Huntley ◽  
John A. Schirger ◽  
Alessandro Cataliotti ◽  
John C. Burnett
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Natriuretic Peptide ◽  
Guanosine Monophosphate ◽  
Phosphodiesterase Inhibition ◽  
Novel Strategy ◽  
Type V

Abstract 15217: Combination Phosphodiesterase V Inhibition and Low Dose B-type Natriuretic Peptide Did Not Enhance Renal Function in Acute Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Scott Hubers ◽  
sherry benike ◽  
Christopher Scott ◽  
Bradley Johnson ◽  
Horng Chen
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Low Dose ◽  
Study Drug ◽  
Cyclic Guanosine Monophosphate ◽  
Urinary Sodium ◽  
Guanosine Monophosphate ◽  
Open Label

Introduction: Cardiorenal dysfunction with impaired cyclic guanosine monophosphate (cGMP) response to volume load is a hallmark of heart failure. Phosphodiesterase V (PDEV) is known to be upregulated and may explain the dysfunction of renal response. Hypothesis: We tested the hypothesis that PDEV inhibition in combination with low dose intravenous (IV) B-type natriuretic peptide (BNP) would improve renal function and potentiate urinary sodium and cGMP excretion in patients with acute heart failure. Methods: Randomized open label study in 67 patients admitted to the hospital with acute heart failure. These patients were randomized to standard care, low dose IV BNP (0.005μg/kg/min), or combination low dose BNP/PDEV inhibition with sildenafil (25 mg q12 hrs) for 48 hours. Plasma and urine studies were obtained at baseline, 24 hours, and 48 hours after study drug initiation to assess renal function. The primary endpoint was the percent change in estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) from baseline to 48 hours. Changes from baseline were summarized with median and quartiles and groups were compared using two-sample t-test. [ClinicalTrials.gov Identifier: NCT00972569] Results: Baseline characteristics were similar between groups. Median age was 78 years and median ejection fraction 39%. Treatment with BNP and BNP/PDEV inhibitor significantly increased plasma cGMP at 24 hr (% increase of 25.6 (8.9, 13.1) and 60.8 (32.3, 103.8) for BNP and BNP/PDEV vs % decrease of 13.5 (-29.1, 14.2) for placebo, p=0.001). BNP levels were significantly higher in both groups at 48 hr compared with placebo. However, there was no significant change in eGFR, BUN, or urinary sodium/cGMP excretion between groups. Hypotension was more common in the BNP/PDEV inhibitor group. Conclusions: Low dose IV BNP and combination BNP/PDEV inhibition increased plasma cGMP in patients with acute heart failure but did not improve renal function or urinary sodium/cGMP excretion. Our study does not support the use of low dose IV BNP with or without PDEV inhibition to enhance renal function in patients admitted with acute heart failure.

scholarly journals Comparison between admission natriuretic peptides, NGAL and sST2 testing for the prediction of worsening renal function in patients with acutely decompensated heart failure

2015 ◽  
Vol 53 (4) ◽  
Author(s):  
Benedetta De Berardinis ◽  
Hanna K. Gaggin ◽  
Laura Magrini ◽  
Arianna Belcher ◽  
Benedetta Zancla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Natriuretic Peptide ◽  
Acute Decompensated Heart Failure ◽  
International Study ◽  
Decompensated Heart Failure ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Amino Terminal ◽  
Worsening Renal Function

AbstractIn order to predict the occurrence of worsening renal function (WRF) and of WRF plus in-hospital death, 101 emergency department (ED) patients with acute decompensated heart failure (ADHF) were evaluated with testing for amino-terminal pro-B-type natriuretic peptide (NT-proBNP), BNP, sST2, and neutrophil gelatinase associated lipocalin (NGAL).In a prospective international study, biomarkers were collected at the time of admission; the occurrence of subsequent in hospital WRF was evaluated.In total 26% of patients developed WRF. Compared to patients without WRF, those with WRF had a longer in-hospital length of stay (LOS) (mean LOS 13.1±13.4 days vs. 4.8±3.7 days, p<0.001) and higher in-hospital mortality [6/26 (23%) vs. 2/75 (2.6%), p<0.001]. Among the biomarkers assessed, baseline NT-proBNP (4846 vs. 3024 pg/mL; p=0.04), BNP (609 vs. 435 pg/mL; p=0.05) and NGAL (234 vs. 174 pg/mL; p=0.05) were each higher in those who developed WRF. In logistic regression, the combination of elevated natriuretic peptide and NGAL were additively predictive for WRF (OR: In ED patients with ADHF, the combination of NT-proBNP or BNP plus NGAL at presentation may be useful to predict impending WRF (Clinicaltrials.gov NCT#0150153).

scholarly journals Impact of Renal Disease on Natriuretic Peptide Testing for Diagnosing Decompensated Heart Failure and Predicting Mortality

2007 ◽  
Vol 53 (8) ◽  
pp. 1511-1519 ◽  
Author(s):  
Christopher R deFilippi ◽  
Stephen L Seliger ◽  
Susan Maynard ◽  
Robert H Christenson
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Natriuretic Peptide ◽  
Estimated Glomerular Filtration Rate ◽  
Area Under The Curve ◽  
Decompensated Heart Failure ◽  
Multivariate Regression Analysis ◽  
Poor Outcomes ◽  
One Year ◽  
Roc Area

Abstract Background: Concomitant occurrence of kidney disease (KD) and heart failure (HF) is common and associated with poor outcomes. Natriuretic peptide studies have typically excluded many individuals with KD. We compared the accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for diagnosing decompensated HF and predicting mortality across the spectrum of renal function. Methods: BNP and NT-proBNP were prospectively measured in a cohort of 831 dyspnea patients. KD was defined as an estimated glomerular filtration rate &lt;60 mL · min−1 · (1.73 m2)−1. The accuracy and predictive value of each test for diagnosing decompensated HF and predicting all-cause 1-year mortality were assessed by ROC area under the curve (AUC) and multivariate regression analysis. Results: Among the 831 dyspnea patients, 393 (47%) had KD. The diagnostic accuracies of BNP and NT-proBNP in detecting decompensated HF were similar to each other in patients without KD (AUC 0.75 vs 0.74, respectively; P = 0.60) and in patients with KD (AUC 0.68 vs 0.66; P = 0.10). One-year mortality rates were 36.3% and 19.0% in those with and without KD, respectively (P &lt;0.001). Progressively higher BNP and NT-proBNP concentrations remained predictive of increased mortality in KD patients. Compared with the lowest quartile, quartile 4 of BNP had an adjusted hazards ratio (HR) of 2.6 (95% CI 1.4–4.8; P = 0.004 for trend) and NT-proBNP quartile 4 had an HR of 4.5 (95% CI 2.0–10.2; P &lt;0.001 for trend). Only NT-proBNP remained a predictor of death after adjustment for clinical confounders and the other natriuretic peptide marker. Conclusions: NT-proBNP and BNP are equivalent predictors of decompensated HF across a spectrum of renal function, but NT-proBNP is a superior predictor of mortality.

scholarly journals Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0235493
Author(s):  
Kenji Yoshioka ◽  
Yuya Matsue ◽  
Takahiro Okumura ◽  
Keisuke Kida ◽  
Shogo Oishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Brain Natriuretic Peptide ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Worsening Renal Function

Brain Natriuretic Peptide Helps Prognosticate Improvement in Renal Function in Acute Heart Failure

2018 ◽  
Vol 24 (8) ◽  
pp. S20-S21
Author(s):  
Yu H. Horiuchi ◽  
Nicholas Wettersten ◽  
Patrick Murray ◽  
Alan Maisel
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Brain Natriuretic Peptide ◽  
Acute Heart Failure ◽  
Natriuretic Peptide

Natriuretic peptide analogues with distinct vasodilatory or renal activity: integrated effects in health and experimental heart failure

2020 ◽  
Author(s):  
Miriam T Rademaker ◽  
Nicola J A Scott ◽  
Cho Yeow Koh ◽  
R Manjunatha Kini ◽  
A Mark Richards
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Natriuretic Peptide ◽  
Acute Decompensated Heart Failure ◽  
Unmet Need ◽  
Urine Volume ◽  
Plasma Renin ◽  
Decompensated Heart Failure ◽  
Guanosine Monophosphate ◽  
High Dose

Abstract Aims Management of acute decompensated heart failure (ADHF) requires disparate treatments depending on the state of systemic/peripheral perfusion and the presence/absence of expanded body–fluid volumes. There is an unmet need for therapeutics that differentially treat each aspect. Atrial natriuretic peptide (ANP) plays an important role in blood pressure and volume regulation. We investigate for the first time the integrated haemodynamic, endocrine and renal effects of human ANP analogues, modified for exclusive vasodilatory (ANP-DRD) or diuretic (ANP-DGD) activities, in normal health and experimental ADHF. Methods and results We compared the effects of incremental infusions of ANP analogues ANP-DRD and ANP-DGD with native ANP, in normal (n = 8) and ADHF (n = 8) sheep. ANP-DRD administration increased plasma cyclic guanosine monophosphate (cGMP) in association with dose-dependent reductions in arterial pressure in normal and heart failure (HF) sheep similarly to ANP responses. In contrast to ANP, which in HF produced a diuresis/natriuresis, this analogue was without significant renal effect. Conversely, ANP-DGD induced marked stepwise increases in urinary cGMP, urine volume, and sodium excretion in HF comparable to ANP, but without accompanying vasodilatory effects. All peptides increased packed cell volume relative to control in both states, and in HF, decreased left atrial pressure. In response to ANP-DRD-induced blood pressure reductions, plasma renin activity rose compared to control only during the high dose in normals, and not at all in HF—suggesting relative renin inhibition, with no increase in aldosterone in either state, whereas renin and aldosterone were both significantly reduced by ANP-DGD in HF. Conclusion These ANP analogues exhibit distinct vasodilatory (ANP-DRD) and diuretic/natriuretic (ANP-DGD) activities, and therefore have the potential to provide precision therapy for ADHF patients with differing pathophysiological derangement of pressure–volume homeostasis.

Role of N-Terminal Pro-Brain Natriuretic Peptide and Cystatin C to Estimate Renal Function in Patients With and Without Heart Failure

2009 ◽  
Vol 103 (8) ◽  
pp. 1128-1133 ◽  
Author(s):  
Sven Linzbach ◽  
Azat Samigullin ◽  
Sezayi Yilmaz ◽  
Maria Tsioga ◽  
Andreas M. Zeiher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Cystatin C
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