Low Dose Intravenous (IV) Infusion of BNP in the Presence and Absence of Acute Type V Phosphodiesterase (PDE V) in Improving Renal Function in Hospitalized Chronic Heart Failure (CHF) Patients With Renal Dysfunction (Aim 3 BNP/PDEV)
Heart Failure, Renal Dysfunction
About this trial
This is an interventional treatment trial for Heart Failure focused on measuring BNP with or without PDE-V in heart failure
Eligibility Criteria
Inclusion Criteria:
- Patients admitted to St Mary's Hospital, Mayo Clinic Rochester MN with NYHA class III-IV decompensated CHF with renal dysfunction as Calculated creatinine clearance of equal or less than 60 ml/min but greater than 20 ml/min using the Cockcroft-Gault formula.
Exclusion Criteria:
- Cause of acute renal dysfunction can be reasonably ascribed to factors other than heart failure or its treatment
- Known intrinsic renal diseases or renal artery stenosis of =>50%
- Patients taking Nitrates within the previous 24 hours
- Patients needing emergency coronary revascularization or those who may have rapidly changing cardiac function (i.e. patients with acute myocardial infarction or shock)
- Peritoneal or hemodialysis within 90 days or anticipation that dialysis or ultrafiltration of any form will be required during the study period
- Systolic blood pressure < 90 mmHg or cardiogenic shock.
- Requirement of pressors for maintenance of blood pressure.
- Intra-aortic blood pump use.
- History of significant uncorrected renal artery stenosis as defined by >50% stenosis.
- Severe aortic or mitral stenosis or significant LV outflow tract obstruction. Hgb < 10 mg/dL
- Pregnant or nursing women.
- Contraindication to nesiritide.
- Inability to have NSAID dose held for up to 30 hours, if being treated with these medications.
- Administration of radiocontrast medium within 7 days of enrollment or anticipated use of such agents during the study
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Active Comparator
No Intervention
BNP with PDE-V
BNP (Nesiritide) will be infused at 0.005 u/Kg/min IV for 48 h
standard care
BNP (Nesiritide) will be infused starting at 0.0025 g/Kg/min IV for 3 hours, if tolerated increased to 0.005 g/kg/min for 45 hours without bolus with PDEV inhibition, they will also receive Sildenafil 12.5 mg at timepoints 0,12, 24 and 36 hours
BNP (Nesiritide) will be infused at 0.025 ug/Kg/min IV for 3 hours then 0.005ug/kg/min 45 hours without bolus. No PDE-V is given.
Patients randomized to this group will continue to receive therapy at the discretion of the heart failure specialist who is managing the patient (with the exception of BNP and low dose dopamine). Blood and Urine will be collected after the patient has been randomized for 48 hours