Clinical Trials

This study has been completed

Inclusion Criteria

• A diagnosis of heart failure as defined by the presence of at least 1 symptom (dyspnea, orthopnea, or edema) and 1 sign (rales on auscultation, peripheral edema, ascites, pulmonary vascular congestion on chest radiography)
• Prior clinical diagnosis of heart failure must be identified within 24 hours of hospital admission (24 hour clock begins when the admission orders are placed)
• Estimated GFR of > 15 but < 60 mL/min/1.73m2 determined by the MDRD equation
• Male or female
• Age ≥ 18 years
• Willingness to provide informed consent
• Ability to have a PICC or central line placed (if needed) within 12 hours of randomization and study drug infusion started
• Anticipated hospitalization of at least 72 hours

Exclusion Criteria

• Received IV vasoactive treatment or ultra-filtration therapy for heart failure since initial presentation
• Anticipated need for IV vasoactive treatment or ultra-filtration for heart failure during this hospitalization
• Systolic BP <90 mmHg
• Hemoglobin (Hgb) < 9 g/dl
• Renal replacement therapy
• History of renal artery stenosis > 50%
• Hemodynamically significant arrhythmias including ventricular tachycardia or defibrillator shock within 4 weeks
• Acute coronary syndrome within 4 weeks as defined by electrocardiographic (ECG) ST-segment depression or prominent T-wave inversion and/or positive biomarkers of necrosis (e.g., troponin) in the absence of ST-segment elevation and in an appropriate clinical setting (chest discomfort or anginal equivalent)
• Active myocarditis
• Hypertrophic obstructive cardiomyopathy
• Greater than moderate stenotic valvular disease
• Restrictive or constrictive cardiomyopathy
• Complex congenital heart disease
• Constrictive pericarditis
• Non-cardiac pulmonary edema
• Clinical evidence of digoxin toxicity
• Need for mechanical hemodynamic support
• Sepsis
• Terminal illness (other than HF) with expected survival of less than 1 year
• Previous adverse reaction to the study drugs
• Use of IV iodinated radiocontrast material in last 72 hours or planned during hospitalization
• Enrollment or planned enrollment in another randomized clinical trial during this hospitalization
• Inability to comply with planned study procedures
• Pregnancy or nursing