Clinical significance of NT-proBNP levels in Chronic Kidney Disease Patients with or without Heart Failure: An Indian Perspective

Abstract

Objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are extremely useful in detecting heart failure (HF). However, the effects of renal inadequacy on NT-proBNP levels in patients presenting with or without HF remains less clear. We sought to examine the correlation of NT-proBNP levels in all CKD patients and cut-off values of NT pro-BNP level for the diagnosis of HF in stable CKD patients as well as CKD patients who are on haemodialysis (HD). Material and Methods: The study comprises 141 CKD patients of both sexes who presented with or without dyspnea to casualty of Lilavati Hospital, Mumbai, India, were prospectively enrolled, and blood samples collected to estimate NT-proBNP level. Results: NT-proBNP cut-off level of 1850 pg/mL for stable CKD patients not on dialysis has a sensitivity of 95% and specificity of 80 %. NT-proBNP cut-off level of 8000pg/ml for CKD patients on HD has a sensitivity of 87 % and specificity of 79%. NT-proBNP cut-off level of 4200 pg/mL for all CKD patients has a sensitivity of 85% and specificity of 81%, for diagnosis of HF. Conclusion: The clinical use of NT-proBNP is a valuable tool for the evaluation of dyspneic patients with suspected HF, irrespective of renal function. We recommend the above NT-proBNP cut-off levels for diagnosing HF patients in the presence of impaired renal function. Evaluation of the correlation between NT-proBNP levels in CKD is important to identify and to design treatment modalities in order to reduce CVD .Therefore, NT-proBNP measurement can be a valuable tool for diagnosis and evaluation of dyspneic patients for early initiation of HF treatment.