Study of Low Dose Nesiritide With or Without Sildenafil in Congestive Heart Failure Patients With Renal Dysfunction (BNP+PDEVI)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00818701
Recruitment Status : Terminated (started a NIH study that is competing for same subjects)
First Posted : January 8, 2009
Last Update Posted : September 24, 2010
Information provided by:
Mayo Clinic

January 6, 2009
January 8, 2009
September 24, 2010
February 2009
August 2010   (Final data collection date for primary outcome measure)
To determine the efficacy of low dose BNP alone vs low dose BNP + PDE V inhibition in improving renal function in patients with CHF and renal dysfunction. (Calculated creatinine clearance = or < than 60 ml/min and > 30 ml/min, within 12 months.) [ Time Frame: prospective ]
Same as current
Complete list of historical versions of study NCT00818701 on Archive Site
We also want to characterize both plasma and urinary humoral profile in these patients. [ Time Frame: prospective ]
Same as current
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Study of Low Dose Nesiritide With or Without Sildenafil in Congestive Heart Failure Patients With Renal Dysfunction
A Randomized, Double Blinded Placebo Controlled Cross-over Study of Low Dose B-type Natriuretic Peptide (Nesiritide) With or Without Concomitant Phosphodiesterase V (PDE V) Inhibition(Sildenafil) in Congestive Heart Failure Patients With Renal Dysfunction
The purpose of the study is to show that low dose recombinant BNP coupled with phosphodiesterase V inhibition will improve renal dysfunction and promote relief of volume overload in patinets with acute decompensated heart failure complicated by the cardiorenal syndrome.

Renal dysfunction is a common comorbidity, as well as a common and progressive complication, of heart failure (HF). Increasingly, the clinical syndrome of HF is one of "cardiorenal" failure owing to the frequent presentation of combined cardiac and renal dysfunction. Recent studies have established the prognostic importance of renal dysfunction in patients with chronic HF. An analysis of the patients in the second prospective randomized study of Ibopamine on mortality and efficacy (PRIME) by Hillege et al1 demonstrated that estimated glomerular filtration rate (GFR) is the most powerful predictor of mortality, exceeding functional status and ejection fraction (EF).

In an ongoing prospective study, we are assessing the neurohumoral and renal hemodynamic profile of hospitalized patients with ADHF who do or do not develop the CRS. Our preliminary findings suggest that indeed the combination of pronounced activation of renin-angiotensin-aldosterone system (RAAS), decreased renal perfusion pressure and importantly, a relative deficiency of the natriuretic peptides (despite marked volume overload) predisposes to the development of CRS.

Phase 1
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Basic Science
  • Congestive Heart Failure
  • Renal Dysfunction
  • Drug: low dose Nesiritide
    Nesiritide infusion 0.005ug/kg/min
    Other Name: Natracor
  • Drug: nesiritide, Sildenafil
    Nesiritide 0.005ug/kg/min Sildenafil 50 mg
    Other Names:
    • Natrecor
    • Viagra
  • Placebo Comparator: 1: low dose BNP alone
    low dose BNP with placebo
    Intervention: Drug: low dose Nesiritide
  • Active Comparator: 2: low dose BNP + PDEVI
    low dose BNpo + PDEVI
    Intervention: Drug: nesiritide, Sildenafil
Not Provided

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
August 2010
August 2010   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Left ventricular ejection fraction 35% assessed by echocardiography, nuclear scan or left ventriculogram within the past 2 years
  • Stable (NYHA) class II and III symptoms as defined by:

    1. no change in NYHA symptoms over the past 3 months;
    2. on stable doses of ACE inhibitor and beta blocker for one month;
    3. no episode of decompensated CHF over the past 3 months.
  • Calculated creatinine clearance of equal or less than 60 ml/min and greater than 30 ml/min, using the Cockcroft-Gault formula assessed within the past 12 months

Exclusion Criteria:

  • Nitrates or alpha blockers
  • Prior diagnosis of intrinsic renal diseases including renal artery stenosis of > 50%
  • Peritoneal or hemodialysis within 90 days or anticipation that dialysis or ultrafiltration of any form will be required during the study period
  • Hospitalization for decompensated CHF during the past 3 months
  • Myocardial infarction within 3 months of screening
  • Unstable angina within 3 months of screening or any evidence of myocardial ischemia
  • Significant valvular stenosis, hypertrophic, restrictive or obstructive cardiomyopathy, constrictive pericarditis, primary pulmonary hypertension, or biopsy proven active myocarditis
  • Severe congenital heart diseases
  • Sustained ventricular tachycardia or ventricular fibrillation within 14 days of screening
  • Second or third degree heart block without a permanent cardiac pacemaker
  • Stroke within 3 months of screening or other evidence of significantly compromised CNS perfusion
  • Serum sodium of < 125 mEq/dL or > 150 mEq/dL
  • Serum potassium of < 3.5 mEq/dL or > 5.7 mEq/dL
  • Hemoglobin < 10 gm/dl
  • Other acute or chronic medical conditions or laboratory abnormality which may increase the risks associated with study participation or may interfere with interpretation of the data
  • Received an investigational drug within 1 month prior to dosing
  • Patients with an allergy to iodine.
  • Female subject who is pregnant or breastfeeding
Sexes Eligible for Study: All
18 Years to 90 Years   (Adult, Older Adult)
Contact information is only displayed when the study is recruiting subjects
United States
Not Provided
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Dr Horng H. Chen, Mayo Clinc
Mayo Clinic
Not Provided
Principal Investigator: Horng H Chen, MD Mayo Clinic
Mayo Clinic
September 2010

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP