Administration of nesiritide in patients after coronary artery bypass surgery induces brisk diuresis.

Recombinant human brain natriuretic peptide, nesiritide, has recently been used in limited studies to enhance postoperative diuresis. A retrospective chart review was conducted at a university hospital to assess the efficacy of nesiritide in cardiac surgery patients with fluid overload refractory to diuretics and dopamine. Nine out of 137 patients who underwent coronary artery bypass grafting at the institution from May 2003 to July 2004 exhibited fluid overload despite diuretics and dopamine. Those who did not respond to the therapy, as manifested by oliguria and heart failure, were started on nesiritide. Urine output, weight change, central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), and serum creatinine were the main outcome measures. Within 6 hours after initiation of nesiritide, the average urine output increased from 28 to 130 mL/h. Serum creatinine levels were not significantly different after 24 hours. The mean CVP decreased from 14 to 10 within 12 hours while the PAWP decreased from 24 to 17 mm Hg. Systemic pressures did not change. One patient had to eventually undergo hemodialysis for complications of renal failure. Our experience demonstrates that infusion of nesiritide in patients with heart failure and fluid overload improves diuresis and hemodynamics without major side effects.