Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial
Horng H Chen, Kevin J Anstrom, Michael M Givertz, Lynne W Stevenson, Marc J Semigran, Steven R Goldsmith, Bradley A Bart, David A Bull, Josef Stehlik, Martin M LeWinter, Marvin A Konstam, Gordon S Huggins, Jean L Rouleau, Eileen O'Meara, W H Wilson Tang, Randall C Starling, Javed Butler, Anita Deswal, G Michael Felker, Christopher M O'Connor, Raphael E Bonita, Kenneth B Margulies, Thomas P Cappola, Elizabeth O Ofili, Douglas L Mann, Víctor G Dávila-Román, Steven E McNulty, Barry A Borlaug, Eric J Velazquez, Kerry L Lee, Monica R Shah, Adrian F Hernandez, Eugene Braunwald, Margaret M Redfield, NHLBI Heart Failure Clinical Research Network, Omar AbouEzzeddine, David Aguilar, Rami Alharethi, Janice Amsler, Inderjit Anand, Feras Bader, Bradley Bart, Cathi Bartolini, Kimberly Boddicker, Raphael Bonita, Barry Borlaug, Corinne Bott-Silverman, Alfred Bove, Rebecca Boxer, Biykem Bozkurt, Jacqueline Bradley, Deborah Budge, Denis Burelle, Javed Butler, Maggie Cabral, Thomas Cappola, William Carlson, Josephine Catanzaro, James Chang, Horng Chen, Robert Cole, Heidi Craddock, Victor Davilla, David DeNofrio, Akshay Desai, Anita Deswal, Andre Dias, Anique Ducharme, Sandra Dunbar, Mark Dunlap, Gregory Ewald, James Fang, Michael Felker, Donna Fiorini, James Fitzpatrick, Viorel Florea, Emiliana Franco, Edward Geltman, Vasiliki Georgiopoulou, Nadia Giannetti, Edward Gilbert, Michael Givertz, Lee Goldberg, Kathleen Gonczarek, Eiran Gorodeski, Diyana Gunawardena, Divya Gupta, Mazen Hanna, Jeffrey Hardin, Robert Hobbs, Christopher Holley, Eileen Hsich, Gordon Huggins, Karen James, Susan Joseph, Andreas Kalogeropoulous, Andrew Keller, Abdallah Kfoury, Michael Kiernan, Robert Kociol, Marvin Konstam, Bonnie Ky, Neal Lakdawala, Rigobert Lapu-Bula, Sonjoy Laskar, Sangjin Lee, Martin LeWinter, Eldrin Lewis, Gregory Lewis, Mark Liszkowski, Sharon Mack, Sulaiman Mapara, Kenneth Margulies, Cathrine Marti, Paul Mather, Markus Meyer, Theo Meyer, Wayne Miller, Geoffrey Mills, Carolyn Moffa, Stephanie Moore, Maria Mountis, Michael Movesian, Matthew Movsesian, Simone Nader, Monique Nestor, Christopher Newton-Cheh, Lazaros Nikolaidis, Kathy Nissley, Anju Nohria, Tareck Nossuli, Christopher O'Connor, Adesoji Oderinde, Adefisayo Oduwole, Elizabeth Ofili, Guilherme Oliveira, Eileen O'Meara, Anekwe Onwuanyi, Anjali Owens, Kimberly Parks, Chetan Patel, Ayan Patel, Kelley Prokop, Pablo Quintero Pinzon, Normand Racine, Jesus Rame, Molly Rater, Lisa Rathman, Syed Raza, Margaret Redfield, Joseph Rogers, Jean Rouleau, Sharon Rubin, Linda Ruppert, Nizar Saleh, Mitchell Saltzberg, Joel Schilling, Marc Semigran, Jeffrey Shih, Jordan Shin, Daniel Sims, Roy Small, Andrew Smith, Dan Sorescu, Randall Starling, Josef Stehlik, Lynne Stevenson, Garrick Stewart, Michael Stillabower, Georgios Syros, Wilson Tang, David Taylor, George Thanassoulis, Lana Tsao, James Udelson, Peter Vanburen, Joyce Wald, Thomas Wang, David Whellan, Michel White, Linda Wick, Horng H Chen, Kevin J Anstrom, Michael M Givertz, Lynne W Stevenson, Marc J Semigran, Steven R Goldsmith, Bradley A Bart, David A Bull, Josef Stehlik, Martin M LeWinter, Marvin A Konstam, Gordon S Huggins, Jean L Rouleau, Eileen O'Meara, W H Wilson Tang, Randall C Starling, Javed Butler, Anita Deswal, G Michael Felker, Christopher M O'Connor, Raphael E Bonita, Kenneth B Margulies, Thomas P Cappola, Elizabeth O Ofili, Douglas L Mann, Víctor G Dávila-Román, Steven E McNulty, Barry A Borlaug, Eric J Velazquez, Kerry L Lee, Monica R Shah, Adrian F Hernandez, Eugene Braunwald, Margaret M Redfield, NHLBI Heart Failure Clinical Research Network, Omar AbouEzzeddine, David Aguilar, Rami Alharethi, Janice Amsler, Inderjit Anand, Feras Bader, Bradley Bart, Cathi Bartolini, Kimberly Boddicker, Raphael Bonita, Barry Borlaug, Corinne Bott-Silverman, Alfred Bove, Rebecca Boxer, Biykem Bozkurt, Jacqueline Bradley, Deborah Budge, Denis Burelle, Javed Butler, Maggie Cabral, Thomas Cappola, William Carlson, Josephine Catanzaro, James Chang, Horng Chen, Robert Cole, Heidi Craddock, Victor Davilla, David DeNofrio, Akshay Desai, Anita Deswal, Andre Dias, Anique Ducharme, Sandra Dunbar, Mark Dunlap, Gregory Ewald, James Fang, Michael Felker, Donna Fiorini, James Fitzpatrick, Viorel Florea, Emiliana Franco, Edward Geltman, Vasiliki Georgiopoulou, Nadia Giannetti, Edward Gilbert, Michael Givertz, Lee Goldberg, Kathleen Gonczarek, Eiran Gorodeski, Diyana Gunawardena, Divya Gupta, Mazen Hanna, Jeffrey Hardin, Robert Hobbs, Christopher Holley, Eileen Hsich, Gordon Huggins, Karen James, Susan Joseph, Andreas Kalogeropoulous, Andrew Keller, Abdallah Kfoury, Michael Kiernan, Robert Kociol, Marvin Konstam, Bonnie Ky, Neal Lakdawala, Rigobert Lapu-Bula, Sonjoy Laskar, Sangjin Lee, Martin LeWinter, Eldrin Lewis, Gregory Lewis, Mark Liszkowski, Sharon Mack, Sulaiman Mapara, Kenneth Margulies, Cathrine Marti, Paul Mather, Markus Meyer, Theo Meyer, Wayne Miller, Geoffrey Mills, Carolyn Moffa, Stephanie Moore, Maria Mountis, Michael Movesian, Matthew Movsesian, Simone Nader, Monique Nestor, Christopher Newton-Cheh, Lazaros Nikolaidis, Kathy Nissley, Anju Nohria, Tareck Nossuli, Christopher O'Connor, Adesoji Oderinde, Adefisayo Oduwole, Elizabeth Ofili, Guilherme Oliveira, Eileen O'Meara, Anekwe Onwuanyi, Anjali Owens, Kimberly Parks, Chetan Patel, Ayan Patel, Kelley Prokop, Pablo Quintero Pinzon, Normand Racine, Jesus Rame, Molly Rater, Lisa Rathman, Syed Raza, Margaret Redfield, Joseph Rogers, Jean Rouleau, Sharon Rubin, Linda Ruppert, Nizar Saleh, Mitchell Saltzberg, Joel Schilling, Marc Semigran, Jeffrey Shih, Jordan Shin, Daniel Sims, Roy Small, Andrew Smith, Dan Sorescu, Randall Starling, Josef Stehlik, Lynne Stevenson, Garrick Stewart, Michael Stillabower, Georgios Syros, Wilson Tang, David Taylor, George Thanassoulis, Lana Tsao, James Udelson, Peter Vanburen, Joyce Wald, Thomas Wang, David Whellan, Michel White, Linda Wick
Abstract
Importance: Small studies suggest that low-dose dopamine or low-dose nesiritide may enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction; however, neither strategy has been rigorously tested.
Objective: To test the 2 independent hypotheses that, compared with placebo, addition of low-dose dopamine (2 μg/kg/min) or low-dose nesiritide (0.005 μg/kg/min without bolus) to diuretic therapy will enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction.
Design, setting, and participants: Multicenter, double-blind, placebo-controlled clinical trial (Renal Optimization Strategies Evaluation [ROSE]) of 360 hospitalized patients with acute heart failure and renal dysfunction (estimated glomerular filtration rate of 15-60 mL/min/1.73 m2), randomized within 24 hours of admission. Enrollment occurred from September 2010 to March 2013 across 26 sites in North America.
Interventions: Participants were randomized in an open, 1:1 allocation ratio to the dopamine or nesiritide strategy. Within each strategy, participants were randomized in a double-blind, 2:1 ratio to active treatment or placebo. The dopamine (n = 122) and nesiritide (n = 119) groups were independently compared with the pooled placebo group (n = 119).
Main outcomes and measures: Coprimary end points included 72-hour cumulative urine volume (decongestion end point) and the change in serum cystatin C from enrollment to 72 hours (renal function end point).
Results: Compared with placebo, low-dose dopamine had no significant effect on 72-hour cumulative urine volume (dopamine, 8524 mL; 95% CI, 7917-9131 vs placebo, 8296 mL; 95% CI, 7762-8830 ; difference, 229 mL; 95% CI, -714 to 1171 mL; P = .59) or on the change in cystatin C level (dopamine, 0.12 mg/L; 95% CI, 0.06-0.18 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, 0.01; 95% CI, -0.08 to 0.10; P = .72). Similarly, low-dose nesiritide had no significant effect on 72-hour cumulative urine volume (nesiritide, 8574 mL; 95% CI, 8014-9134 vs placebo, 8296 mL; 95% CI, 7762-8830; difference, 279 mL; 95% CI, -618 to 1176 mL; P = .49) or on the change in cystatin C level (nesiritide, 0.07 mg/L; 95% CI, 0.01-0.13 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, -0.04; 95% CI, -0.13 to 0.05; P = .36). Compared with placebo, there was no effect of low-dose dopamine or nesiritide on secondary end points reflective of decongestion, renal function, or clinical outcomes.
Conclusion and relevance: In participants with acute heart failure and renal dysfunction, neither low-dose dopamine nor low-dose nesiritide enhanced decongestion or improved renal function when added to diuretic therapy.
Trial registration: clinicaltrials.gov Identifier: NCT01132846.
Conflict of interest statement
Author Conflict of Interest Disclosures
HH Chen: Dr. Chen
KJ Anstrom: Dr. Anstrom
MM Givertz: Dr. Givertz
LW Stevenson: Dr. Stevenson
MJ Semigran: Dr. Semigran
SR Goldsmith: Dr. Goldsmith
BA Bart: Dr. Bart
DA Bull: Dr. Bull
J Stehlik: Dr. Stehlik
MM LeWinter: Dr. LeWinter
MA Konstam: Dr. Konstam
GS Huggins: Dr. Huggins
JL Rouleau: Dr. Rouleau
E O’Meara: Dr. O’Meara
WHW Tang: Dr. Tang
RC Starling: Dr. Starling
J Butler: Dr. Butler
A Deswal: Dr. Deswal
GM Felker: Dr. Felker
CM O’Connor: Dr. O’Connor
RE Bonita: Dr. Bonita
KB Margulies: Dr. Margulies
TP Cappola: Dr. Cappola
EO Ofili: Dr. Ofili
DL Mann: Dr. Mann
VG Davila-Roman: Dr. Davila-Roman
SE McNulty: Dr. McNulty
BA Borlaug: Dr. Borlaug
EJ Velazquez: Dr. Velazquez
KL Lee: Dr. Lee
MR Shah: Dr. Shah
AF Hernandez: Dr. Hernandez
E Braunwald: Dr. Braunwald
MM Redfield: Dr. Redfield
Figures
Source: PubMed