Cardiovascular Disease in Patients With Chronic Renal Impairment: Role of Natriuretic Peptides

Vanderheyden, Marc; Bartúnek, Jozef; Filippatos, Gerasimos; Goethals, Marc; Vlem, Bruno Van; Maisel, Alan S.

doi:10.1111/j.1751-7133.2008.08344.x

Cited by 9 publications

(6 citation statements)

References 56 publications

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“…The strong effect of renal dysfunction on NT -proBNP levels contributes to the decreased sensitivity and specificity questionable. 18,19 We observed kidney dysfunction (defined as estimated glomerular filtration rate <60 ml/min/1.73 m 2 ) in 36% of the patients in our study. The serum NT -proBNP concentration is profoundly affected by renal dysfunction…”

Section: Discussionmentioning

confidence: 56%

Prognostic utility of the N terminal prohormone of brain natriuretic peptide and the modified Model for End Stage Liver Disease in patients with end stage heart failure

Szczurek¹,

Szyguła‐Jurkiewicz²,

Zakliczyński³

et al. 2018

Polish Archives of Internal Medicine

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INTRODUCTION The N terminal prohormone of brain natriuretic peptide (NT proBNP) is secreted by cardiomyocytes in response to increased wall stress resulting from pressure and volume overload. The modified Model for End Stage Liver Disease (modMELD) scale reflects the systemic effect of heart failure (HF), which includes end-organ congestion and subsequent hepatic and renal dysfunction. OBJECTIVES The aim of this study was to assess the prognostic accuracy of NT proBNP and the modMELD score, as well as to compare their usefulness in the risk stratification of patients with end-stage HF awaiting orthotopic heart transplantation (OHT). PATIENTS AND METHODS We retrospectively analyzed the data of 641 consecutive adult patients awaiting OHT between 2012 and 2016. Exclusion criteria included "urgent status", OHT, and removal from the waiting list. Clinical and laboratory data were obtained at the time of admission to the waiting list. The primary endpoint was all-cause mortality during a one-year follow up. RESULTS In the overall population of 370 patients, the median age was 54.0 (46.0-60.0) years, and 87.6% of the patients were male. During the follow-up period, the mortality rate was 27.6%. The areas under the curve (AUCs) were 0.619 (95% CI: 0.557-0.681) for NT proBNP and 0.870 (95% CI: 0.833-0.906) for modMELD. The difference between the AUC for modMELD and NT proBNP was 0.251 (95% CI: 0.179-0.322, P <0.0001). CONCLUSIONS The usefulness of NT proBNP in evaluating the prognosis of patients with end stage HF awaiting OHT is limited. The modMELD score is a better prognostic marker of waiting list mortality than the NT proBNP serum concentration.

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Section: Discussionmentioning

confidence: 56%

Prognostic utility of the N terminal prohormone of brain natriuretic peptide and the modified Model for End Stage Liver Disease in patients with end stage heart failure

Szczurek¹,

Szyguła‐Jurkiewicz²,

Zakliczyński³

et al. 2018

Polish Archives of Internal Medicine

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“…To mediate its action, BNP is metabolized by specific natriuretic peptide receptors found in kidney, lung, liver, and along the vascular endothelium, while the NT BNP is mainly cleared by the kidneys. 12 In a recent review, Vanderheyden et al 13 observed that, despite the potential usefulness of both BNP and Nt-proBNP in diagnosis and management of patients with heart failure, including monitoring of response to drugs and a considerable body of literature exploring the usefulness of these biomarkers relative to these assessments, optimal strategies for their application in the clinical context remain undefined. Outcomes of other studies 17,18 however, suggested to Tagore et al 19 that the relationship between renal function and BNP levels may be most strongly dependent on cardiac and volume-related factors.…”

Section: Discussionmentioning

confidence: 99%

Association of B-Type Natriuretic Peptide Levels With Estimated Glomerular Filtration Rate and Congestive Heart Failure

Wiley¹,

Switzer²,

Berg³

et al. 2009

Clinical Medicine & Research

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BNP levels show a strong inverse association with eGFR in both CHF and non-CHF patients. Currently best practice at most institutions involves use of BNP cutoff diagnostic levels not adjusted for eGFR. The data presented underlines that eGFR is a significant confounder of BNP measurement especially when renal status is compromised and interpretation of clinical significance in the presence of elevated BNP measures should take renal status into consideration.

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“…Recently, the prognostic potential of plasma BNP concentrations has been investigated in several studies on patients with CKD and patients on hemodialysis and peritoneal dialysis (15,16 ). However, the diagnostic accuracy of plasma BNP and NT-proBNP concentrations for HF has been reported to be reduced in this setting (17 ). It is not yet clear whether, in HF patients with CKD and ESRD, increased plasma BNP concentrations might be due to more hemodynamic stimuli or might result from other factors such as anemia, obesity and cachexia, or impaired renal clearance of natriuretic peptide, despite similar hemodynamic stimuli.…”

confidence: 99%

Impact of Left Ventricular End-Diastolic Wall Stress on Plasma B-Type Natriuretic Peptide in Heart Failure with Chronic Kidney Disease and End-Stage Renal Disease

et al. 2009

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BACKGROUND: Plasma B-type natriuretic peptide (BNP) is a diagnostic and prognostic marker in heart failure (HF). Although renal function is reported as an important clinical determinant, precise evaluations of the relationships of renal function with hemodynamic factors in determining BNP have not been performed. Therefore, we evaluated the association of plasma BNP concentrations with LV end-diastolic wall stress (EDWS) in a broad range of HF patients including those with chronic kidney disease (CKD) and endstage renal disease (ESRD). METHODS:In 156 consecutive HF patients including those with CKD and ESRD, we measured plasma BNP and performed echocardiography and cardiac catheterization. LV EDWS was calculated as a crucial hemodynamic determinant of BNP. RESULTS:Plasma BNP concentrations increased progressively with decreasing renal function across the groups (P Ͻ 0.01) and were correlated with LV EDWS (r ϭ 0.47) in the HF patients overall. This relationship was also present when patients were subdivided into systolic and diastolic HF (P Ͻ 0.01). In multivariable analysis, higher EDWS was associated with increased BNP concentration independently of renal dysfunction (P Ͻ 0.01). Anemia, systolic HF, and decreased BMI also contributed to increased BNP concentrations. CONCLUSIONS:These results suggest that LV EDWS is a strong determinant of BNP even in patients with CKD and ESRD. Anemia, obesity, and HF type (systolic or diastolic) should also be considered in interpreting plasma BNP concentrations in HF patients. These findings may contribute to the clinical management of HF patients, especially those complicated with CKD and ESRD. © 2009 American Association for Clinical ChemistryChronic kidney disease (CKD) 5 is frequently associated with a progressive decrease in glomerular filtration rate (GFR), which leads to end-stage renal disease (ESRD) (1 ). The number of patients with CKD as well as ESRD is increasing markedly worldwide (2, 3 ). Several investigators have documented that patients with CKD are at higher risk of cardiovascular disease than the general population, and show a higher rate of cardiovascular mortality (4-6 ). In particular, ESRD patients have a 500-fold greater rate of cardiovascular mortality than age-matched controls with normal renal function (7 ). Heart failure (HF) is also an increasingly prevalent condition and the leading cause of death among cardiovascular diseases in patients with CKD and ESRD (8 ). There may be some interaction between heart disease and kidney disease, and HF patients who have CKD or ESRD show a worse prognosis (9, 10 ). Thus, early diagnosis and aggressive management of HF are needed in patients with CKD and ESRD. Conversely, early recognition and management of CKD are also necessary in patients with HF.B-type natriuretic peptide (BNP) is synthesized in the ventricular myocardium in response to ventricular stretching and wall stress (11 ). BNP and N-terminal pro-BNP (NT-proBNP), which are associated with the severity of HF and left ventricular (LV) function, are...

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Cardiovascular Disease in Patients With Chronic Renal Impairment: Role of Natriuretic Peptides

Cited by 9 publications

References 56 publications

Prognostic utility of the N terminal prohormone of brain natriuretic peptide and the modified Model for End Stage Liver Disease in patients with end stage heart failure

Prognostic utility of the N terminal prohormone of brain natriuretic peptide and the modified Model for End Stage Liver Disease in patients with end stage heart failure

Association of B-Type Natriuretic Peptide Levels With Estimated Glomerular Filtration Rate and Congestive Heart Failure

Impact of Left Ventricular End-Diastolic Wall Stress on Plasma B-Type Natriuretic Peptide in Heart Failure with Chronic Kidney Disease and End-Stage Renal Disease

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