Amino-Terminal Pro-B-Type Natriuretic Peptide for Diagnosis and Prognosis in Patients With Renal Dysfunction

Abstract

Structured Abstract Objectives To determine if Amino-terminal Pro B-type Natriuretic Peptide (NT-proBNP) has different diagnostic and prognostic utility in patients with renal dysfunction. Background Patients with renal dysfunction have higher NT-proBNP, which may complicate interpretation for diagnosis of acute decompensated heart failure (ADHF) or prognosis. Methods We searched MEDLINE and EMBASE through August 2014 for studies with a subgroup analysis by renal function of the diagnostic or prognostic ability of NT-proBNP. Results For diagnosis, nine studies were included with 4,287 patients and 1,325 ADHF events. Patients were mostly divided into sub-groups with and without renal dysfunction by an estimated glomerular filtration rate of 60 ml/min/1.73m2. In patients with renal dysfunction, the area under the curve (AUC) for NT-proBNP ranged from 0.66 to 0.89 with a median cut-point of 1980 pg/ml, while the AUC ranged from 0.72 to 0.95 with a cut-point of 450 pg/ml in patients with preserved renal function. For prognosis, 30 studies with 32,203 patients were included, and mortality in patients with renal dysfunction (25.4%) was twice that of patients with preserved renal function (12.2%). The unadjusted pooled risk ratio (RR) for NT-proBNP and mortality was 3.01 (95% CI, 2.53-3.58) in patients with preserved renal function and was similar in patients with renal dysfunction (3.25 [CI, 2.45-4.30]). Upon meta-regression, heterogeneity was partially explained if patients with heart failure or coronary artery disease were enrolled. Conclusions NT-proBNP retains utility for diagnosis of ADHF in patients with renal dysfunction with higher cut-points. Elevated NT-proBNP confers a worse prognosis regardless of renal function.

N-terminal Pro-B-Type Natriuretic Peptide and Malnutrition in Patients on Hemodialysis

“…us, elevated levels of the prohormone are often observed in HD patients without clinical evidence of cardiovascular disease. ese high NT-proBNP levels in patients with renal dysfunction [11,12,[18][19][20] were higher than in individuals with normal renal function.…”

The impact of renal function on the prognostic value of N-terminal pro–B-type natriuretic peptide in patients with coronary artery disease

“…The use of NT-proBNP level in diagnosis has been recommended by guidelines for managing heart failure and acute coronary syndrome (ACS) in clinical practice [16,17]. However, several studies have found that blood NT-pro-BNP levels may be significantly affected by renal function [6]. This study found that NT-proBNP level is negatively correlated with eGFR in CAD patients, and the level is significantly elevated in patients with eGFRs of less than 60 mL/min/1.73 m 2 compared with patients with eGFRs of at least 90 mL/min/1.73 m 2 .…”

“…Prior studies have shown that for such patients, NT-proBNP level is significantly correlated with eGFR; in particular, NT-proBNP level increases as eGFR decreases [5,6]. Moreover, investigations have also revealed that the combined use of NT-proBNP level and eGFR can improve the identification of patients at high risk of acute myocardial infarction and heart failure [7][8][9].…”

Usefulness of N-terminal-pro B-type natriuretic peptide as a heart failure marker in patients undergoing percutaneous left atrial appendage occlusion

“…Whereas, in the case of acute symptoms, a value of 300 pg/mL is thought to be abnormal. However, the increase of NT-proBNP concentration may occur in other conditions, including right ventricular overload, myocardial ischaemia, hypoxemia, renal dysfunction, liver cirrhosis, sepsis, and infection [9][10][11][12]. Even though NT-proBNP is increased in these conditions, it remains valuable in the HF diagnosis, but different cut-off values are suggested.…”