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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;13\\\/20\\\/15\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;13\\\/20\\\/15\u0022}],\u0022ac\u0022:{\u0022spmdc;13\\\/20\\\/15\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;13\\\/20\\\/15\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn the Renal Optimization Strategies Evaluation in Acute Heart Failure Study [ROSE AHF; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01132846\u0026amp;atom=%2Fspmdc%2F13%2F20%2F15.atom\u0022\u003ENCT01132846\u003C\/a\u003E] treatment with low-dose dopamine or low-dose nesiritide did not improve renal dysfunction compared with placebo. The results were part of a National Heart, Lung, and Blood Institute-funded study.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn the Renal Optimization Strategies Evaluation in Acute Heart Failure Study [ROSE AHF; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01132846\u0026amp;atom=%2Fspmdc%2F13%2F20%2F15.atom\u0022\u003ENCT01132846\u003C\/a\u003E] treatment with low-dose dopamine or low-dose nesiritide did not improve renal dysfunction compared with placebo. The results of the National Heart, Lung, and Blood Institute -funded study were presented by Horng H. Chen, MD, Mayo Clinic, Rochester, Minnesota, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EROSE-AHF examined whether the addition of low-dose dopamine (2 \u03bcg\/kg\/min) or low-dose nesiritide (0.005 \u03bcg\/kg\/min without bolus) to diuretic therapy would enhance decongestion and preserve renal function when compared with placebo in patients with acute heart failure (AHF) and \u22651 symptom (dyspnea, orthopnea, edema) or \u22651 sign (rales, edema, ascites, chest x-ray), and an estimated glomerular filtration rate (eGFR) 15 to 60 mL\/min\/1.73 m\u003Csup\u003E2\u003C\/sup\u003E. For the first 24 hours, all patients received standardized diuretic dosing (2.5-times the outpatient dose) and patients were enrolled within 24 hours of hospitalization.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe randomization schema and number of patients in each group are shown in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E. The two coprimary endpoints were cumulative urinary volume from randomization through 72 hours (decongestion endpoint), and change in serum cystatin-C concentration from randomization to 72 hours (renal function endpoint).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/20\/15\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022ROSE AHF Study Design\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-223687313\u0022 data-figure-caption=\u0022ROSE AHF Study Design\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/20\/15\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/20\/15\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/20\/15\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13316\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EROSE AHF Study Design\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from H Chen, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EPatients randomized had a median age of 70 years, 73% were male, and 26% had an ejection fraction (EF) \u0026gt;50%. Over half of patients (67%) had been hospitalized for AHF in the prior year. Their median eGFR was 44.5 mL\/min\/1.73 m\u003Csup\u003E2\u003C\/sup\u003E, NT-proBNP was 4972 pg\/mL, and the median outpatient dose of furosemide was 80 mg\/day.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EResults for the dopamine strategy showed no significant difference between active treatment and placebo in 72-hour urine volume (8.5 vs 8.3 L, respectively; p=0.58), or cystatin-C concentration (0.12 vs 0.11 mg\/L; p=0.72). The lack of effect was consistent across prespecified subgroups, except for patients with preserved EF (\u0026gt;50%) who tended to have lower urine volume with dopamine compared with placebo (p=0.01).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ENo significant treatment effect was seen with dopamine on secondary endpoints related to decongestion, renal function, or symptom relief. There was less study drug dose reduction or discontinuation due to hypotension in the dopamine group, but they were more likely to have study drug dose reduction or discontinuation due to tachycardia. The overall incidence of study drug discontinuation before 72 hours due to any cause was similar between the two groups. As for clinical outcomes, the composite of 60-day death, unscheduled visits, or HF readmission was similar between the two groups (HR, 1.15; 95% CI, 0.74 to 1.78; p=0.53), as was the rate of 180-day mortality (HR, 0.95; 95% CI, 0.54 to 1.68; p=0.87).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn the nesiritide group, there was no significant difference between active treatment and placebo in 72-hour urine volume (8.6 vs 8.3 L, respectively; p=0.25), or cystatin-C concentration (0.07 vs 0.11 mg\/L, respectively; p=0.35). The lack of benefit was consistent across prespecified subgroups. There was a nonsignificant trend suggesting a differential effect in patients with reduced EF compared with patients with preserved EF. Patients with reduced EF who received nesiritide tended to have greater urine output volume (p=0.06) and less change in cystatin-C concentration when compared with patients receiving placebo (p=0.09). There was no significant treatment effect on secondary endpoints related to decongestion, renal function, or symptom relief. Patients receiving nesiritide had rates of study drug dose reduction or discontinuation due to hypotension that were numerically higher than in patients receiving placebo (18.8% vs 10.4%; p=0.07). The overall incidence of study drug discontinuation before 72 hours for any reason was similar in both the treatment and placebo group (25% vs 25%; p=0.94). The rate of 180-day mortality was similar between the groups (HR, 0.91; 95% CI, 0.51 to 1.61; p=0.74). The composite rate of 60-day death, unscheduled visits, or HF readmission, however, showed a nonsignificant trend favoring nesiritide (HR, 0.71; 95% CI, 0.44 to 1.15; p=0.16).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EIn patients with AHF and underlying renal dysfunction, neither low-dose dopamine nor low-dose nesiritide when added to diuretics enhanced decongestion or improved renal function. Further investigations of these, or other, AHF therapies should assess the potential for differential responses in HF with preserved versus reduced EF, stated Dr. Chen.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/20\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznjlq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznjlq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}