Effects of BG9719 (CVT-124), an A(1)-adenosine receptor antagonist, and furosemide on glomerular filtration rate and natriuresis in patients with congestive heart failure

OBJECTIVES To determine the effects of furosemide and the selective A(1) ad enosine receptor BG9719 on renal function in patients with congestive heart failure (CHF). BACKGROUND Studies suggest that adenosine may affect renal function by vari ous mechanisms, but the effects of blockade of this system in humans is unk nown. In addition, the effects of a therapeutic dose of furosemide oil glom erular filtration rate (GFR) and renal plasma flow (RPF) in heart failure p atients are controversial. METHODS On different days, 12 patients received placebo, BG9719 and furosem ide. Glomerular filtration rate, RPF and sodium and water excretion were as sessed immediately following drug administration. RESULTS Glomerular filtration rate was 84 +/- 23 ml/min/1.73m(2) after rece iving placebo, 82 +/- 24 following BG9719 administration and a decreased (p < 0.005) 63 +/- 18 following furosemide. Renal plasma flow was unchanged a t 293 +/- 124 ml/min/1.73m(2) on placebo, 334 +/- 155 after receiving BG971 9 and 374 +/- 231 after receiving furosemide. Sodium excretion increased fr om 8 +/- 8 mEq following placebo administration to 37 +/- 26 mEq following BG9719 administration. In the six patients in whom it was measured, sodium excretion was 104 +/- 78 mEq following furosemide administration. CONCLUSIONS Natriuresis is effectively induced by both furosemide and the a denosine A(1) antagonist BG9719 in patients with CHF. Doses of the two drug s used in this study did not cause equivalent sodium and water excretion bu t only furosemide decreased GFR. These data suggest that adenosine is an im portant determinant of renal function in patients with heart failure. (C) 1 999 by the American College of Cardiology.