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Nutrition and Heart Failure
Published in David Heber, Zhaoping Li, Primary Care Nutrition, 2017
Nesiritide is a recombinant form of B-type natriuretic peptide and is used for the treatment of acute decompensated HF. Nesiritide has potent vasodilatory properties and reduces pulmonary capillary wedge pressure effectively. This results in improvement of dyspnea.
Pharmacological therapy
Published in ILEANA PIÑA, SIDNEY GOLDSTEIN, MARK E DUNLAP, The Year in Heart Failure, 2005
KIRKWOOD ADAMS, HERBERT PATIERSON
The treatment of acute decompensated heart failure remains of significant interest, as this major public health problem continues to present a major morbidity and mortality burden and economic consequence for patients with heart failure. Knowledge concerning nesiritide, one of the few therapies for acute heart failure supported by randomized clinical trial results, continues to accumulate. Several studies on diverse aspects of this drug continue to testify to its clinical utility. Finally, new data on inotropic agents and a number of investigational pharmaceutical agents are reviewed. Digoxin remains a controversial drug for many, but new data suggest that optimal dosing may help to improve outcomes on this therapy. New results with antagonism of vasopressin and endothelin-1 raise the possibility that inhibition of these neurohormones may produce clinical benefits in patients with heart failure. All of the above work serves to highlight the continued public health and clinical importance of heart failure, a syndrome which still claims too many lives and impairs quality oflife too often. Application of new information reviewed in this section will provide additional strategies for the more effective treatment of this syndrome.
The pathophysiology and management of diuretic resistance in patients with heart failure
Published in Hospital Practice, 2022
Steven G. Chrysant, George S. Chrysant
Diuretic resistance to the treatment of patients with CHF is common ranging between 20% and 50% of patients with advanced CHF, especially in the presence of renal functional impairment. Among the diuretics used, loop diuretics are the line of therapy with furosemide being the most commonly employed, although other loop diuretics like bumetanide and torsemide are more potent and longer acting, like torsemide. If resistance to loop diuretics persists after the use of maximal doses ranging from 200 to 300 mg/day, the resistance can be overcome with the addition of other diuretics like thiazide and thiazide-like, mineralocorticoid receptor antagonists (MRAs), as well as the sodium-glucose co-transporter 2 (SGLT2) inhibitors acting at different segments of the renal tubule and have complementary effects. Other drugs used in acute decompensated heart failure include dopamine, nesiritide, and the vasopressin-2 inhibitor tolvaptan. This latter drug is particularly useful in patients with CHF and diuretic-induced hyponatremia, because they increase the free water clearance and improve the hyponatremia.
Neprilysin, the kidney brush border neutral proteinase: a possible potential target for ischemic renal injury
Published in Toxicology Mechanisms and Methods, 2020
Runali Sankhe, Manas Kinra, Jayesh Mudgal, Devinder Arora, Madhavan Nampoothiri
Exogenous recombinant human BNP (nesiritide) initially showed good renal and hemodynamic action in a patient with heart failure. But in large-scale randomized control trial ASCEND-HF, the clinical effectiveness of nesiritide was insignificant. The similar trial also concluded that the routine use of nesiritide could not be recommended (O’Connor et al. 2011; Kelly et al. 2015). Similarly, the renal function in critically ill patients was unable to improve by synthetic analogs of ANP, carperitide, and anaritide (Allgren et al. 1997; Wang et al. 2004). Apart from that, exogenous NP’s treatment possesses the drawbacks such as intravenous administration and less patient compliance. Another hurdle in treatment with exogenous NPs is the cost of therapy (Malek and Gaikwad 2017). Administration of exogenous NPs represents the first way of increasing NPs levels in ischemic kidney injury. Another strategy to increase NPs level is the inhibition of NEP by NEP inhibitors. In vivo study on Zucker obese rats indicated that the treatment with sacubitril/valsartan resulted in significant attenuation in glomerular, tubular injury, renal ultrastructure, and proteinuria. The study also suggested that NPs mediate the upregulation of cGMP and contribute to the renoprotective effect of sacubitril/valsartan as a comparison with valsartan monotherapy (Habibi et al. 2019).
Negotiating renal dysfunction when treating patients with heart failure
Published in Expert Review of Cardiovascular Therapy, 2018
Valentina Carubelli, Marco Metra, Lars H. Lund
In patients with advanced HF and/or with renal impairment, furosemide may be not enough to relieve signs and symptoms of congestion. Torasemide has a favorable pharmacological profile, with a better absorption and higher bioavailability compared to furosemide, and has anti-fibrotic properties [114,115]. Since torasemide is frequently used when patients develop tolerance to furosemide, it is not surprising that in observational studies, torasemide-treated patients are sicker and have worse outcomes [116,117]. However, findings from the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial showed that although torasemide was administered in a minority of patients (13%) with more advanced HF and renal dysfunction, it was associated with a nominal improvement of 30-day outcomes [118]. Prospective randomized studies are needed to ascertain if there is a meaningful difference between torsemide and furosemide. An adjunctive therapy to furosemide, widely used in clinical practice in patients with diuretic resistance, is metolazone. However, it is associated with a high risk of adverse events such as renal function deterioration and electrolytes disturbance (hyponatremia, hypokalemia) [119,120], and its clinical efficacy is largely based just on empiric experience. MRAs at ‘diuretic dosage’ are another possible adjunctive therapy and are under investigation in the ATHENA-HF study. The study is a randomized, double-blind, placebo-controlled trial which will investigate the safety and efficacy of spironolactone (100 mg/day) vs. placebo in patients hospitalized for AHF. The primary end point will be the change of natriuretic peptide while secondary end point will include measures of clinical decongestion and outcomes [121].