Addition of certain drugs to diuretic therapy does not improve kidney function

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The JAMA Network Journals
Addition of certain drugs to diuretic therapy does not improve kidney function Chicago – Horng H. Chen, M.B.B.Ch., of the Mayo Clinic, Rochester, Minn., and colleagues conducted a randomized trial to determine whether, as compared with placebo, the addition of low-doses of the drugs dopamine or nesiritide to diuretic therapy would enhance urine output and preserve kidney function in patients with acute heart failure and kidney dysfunction.

"Primary treatment goal in acute heart failure is to achieve adequate [urine output] while avoiding renal dysfunction and other adverse effects. Patients with acute heart failure and moderate or severe renal dysfunction are at risk for inadequate [urine output] and worsening renal function, both of which are associated with worse outcomes," according to background information in the article. "Small studies suggest that low-dose dopamine or low-dose nesiritide may enhance [urine output] and preserve renal function in patients with acute heart failure and renal dysfunction; however, neither strategy has been rigorously tested."

The multicenter, clinical trial included 360 hospitalized participants with acute heart failure and renal dysfunction.

The researchers found that compared with placebo, low-dose dopamine had no effect on 72-hour cumulative urine volume (a measure of decongestion) or on a measure of kidney function. Similarly, low-dose nesiritide had no effect on these measures. There was no effect of low-dose dopamine or low-dose nesiritide on other urine measure, weight change, renal function, or clinical outcomes, compared with placebo.

"These findings do not support the use of low-dose dopamine or low-dose nesiritide as a renal adjuvant therapy in patients with acute heart failure and renal dysfunction," the authors write. ### (doi:10.l001/jama.2013.282190; Available pre-embargo to the media at http://media.jamanetwork.com)