Correlates of N-Terminal Prohormone Brain Natriuretic Peptides in African Americans with Hypertensive Chronic Kidney Disease: The African American Study of Kidney Disease and Hypertension

Yi, Stella S.; Contreras, Gabriel; Miller, Edgar R.; Appel, Lawrence J.; Astor, Brad C.

doi:10.1159/000159276

Cited by 8 publications

(9 citation statements)

References 53 publications

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“…There has been reluctance to adopt the use of NT-proBNP as a biomarker for HF in the CKD population because of the concern that elevated levels might simply be a reflection of reduced clearance from diminished GFR. 8,27 However, similar to our findings, several studies have shown that NT-proBNP levels are strongly associated with cardiovascular events, independent of eGFR levels, in patients with CKD. [28][29][30] In the African-American Study of Kidney Disease and Hypertension, a study of hypertensive black patients with CKD, for each doubling of NT-proBNP, there was a 70% increased risk of HF.…”

Section: Discussionsupporting

confidence: 90%

High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

Bansal

Anderson

Yang

et al. 2015

Journal of the American Society of Nephrology

111

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High-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) strongly predict heart failure (HF) in the general population. However, the interpretation of levels of these biomarkers as predictors of HF is uncertain among patients with CKD. Here, we investigated whether hsTnT and NTproBNP are associated with incident HF among patients with CKD. In a prospective cohort analysis, we studied 3483 people with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study recruited from June of 2003 to August of 2008 who were free of HF at baseline. We used Cox regression to examine the association of baseline levels of hsTnT and NT-proBNP with incident HF after adjustment for demographic factors, traditional cardiovascular risk factors, markers of kidney disease, pertinent medication use, and mineral metabolism markers. At baseline, hsTnT levels ranged from #5.0 to 378.7 pg/ml, and NT-proBNP levels ranged from #5 to 35,000 pg/ml. Compared with those who had undetectable hsTnT, participants in the highest quartile (.26.5 ng/ml) had a significantly higher rate of HF (hazard ratio, 4.77; 95% confidence interval, 2.49 to 9.14). Similarly, compared with those in the lowest NT-proBNP quintile (,47.6 ng/ml), participants in the highest quintile (.433.0 ng/ml) experienced a substantially higher rate of HF (hazard ratio, 9.57; 95% confidence interval, 4.40 to 20.83). In conclusion, hsTnT and NT-proBNP were strongly associated with incident HF among a diverse cohort of individuals with mild to severe CKD. Elevations in these biomarkers may indicate subclinical changes in volume and myocardial stress that subsequently contribute to clinical HF.

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Section: Discussionsupporting

confidence: 90%

High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

Bansal

Anderson

Yang

et al. 2015

Journal of the American Society of Nephrology

111

View full text Add to dashboard Cite

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“…NT-pro-BNP is more stable, with a longer half-life, and may be a better biomarker for chronic volume expansion or stress than is BNP (23). Reduced renal function decreases the fractional plasma clearance of both BNP and NT-pro-BNP, and studies reported correlations between graded elevations in these peptides and declining eGFR or advancing CKD stages (Table 2) (22,(24)(25)(26)(27)(28)(29)(30)(31)(32). The clearance of NT-pro-BNP is predominantly renal, while BNP is also degraded systemically ( Figure 2) (23).…”

Section: Bnp and Nt-pro-bnp In Ckdmentioning

confidence: 99%

Utility of Traditional Circulating and Imaging-Based Cardiac Biomarkers in Patients with Predialysis CKD

Colbert

Jain

Lemos

et al. 2015

Clinical Journal of the American Society of Nephrology

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Cardiac biomarkers, such as cardiac troponin T (cTnT), brain natriuretic peptide (BNP), and N-terminal-pro-BNP (NT-pro-BNP), are commonly used to diagnose acute coronary syndrome and congestive heart failure exacerbation in symptomatic patients. Levels of these biomarkers are frequently chronically elevated in asymptomatic patients with ESRD who are receiving maintenance dialysis. Other imaging biomarkers commonly encountered in nephrologists' clinical practice, such as coronary artery calcium measured by computed tomography, left ventricular hypertrophy, and carotid intima-media thickness, are also frequently abnormal in asymptomatic patients with ESRD. This article critically reviews the limited observational data on associations between cTnT, BNP, NT-pro-BNP, coronary artery calcium, left ventricular hypertrophy, and carotid intimamedia thickness with cardiovascular events and death in non-dialysis-dependent patients with CKD. Although sufficient evidence suggests that these biomarkers may be used for prognostication, the diagnostic utility of cTnT, BNP, and NT-pro-BNP remain challenging in patients with CKD. Decreased renal clearance may affect the plasma levels of these biomarkers, and upper reference limits were originally derived in patients without CKD. Until better data are available, higher cutoffs, or a rise in level compared with previous values, have been proposed to help distinguish acute myocardial infarction from chronic elevations of cTnT in symptomatic patients with CKD. Additionally, it is not known whether these biomarkers are modifiable and amenable to interventions that could change hard clinical outcomes in patients with CKD not yet undergoing long-term dialysis.

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“…BNP levels have also been correlated positively with MA cross-sectionally in some clinical reports. 31 There are multiple potential mechanisms whereby aldosterone may lead to altered kidney function, including inflammation and fibrosis. 32 Rats with hypertension that drank saline-infused water had reduced albuminuria on treatment with spironolactone.…”

Section: Potential Mechanismsmentioning

confidence: 99%

A Multi-Marker Approach to Predict Incident CKD and Microalbuminuria

Fox¹,

Gona²,

Larson³

et al. 2010

Journal of the American Society of Nephrology

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Traditional risk factors do not adequately identify individuals at risk for CKD. We related a multi-marker panel consisting of the following seven circulating biomarkers to the incidence of CKD and microalbuminuria (MA) in 2345 participants who attended the sixth Framingham Offspring Study examination (1995 to 1998): C-reactive protein, aldosterone, renin, B-type natriuretic peptide (BNP), plasminogen-activator inhibitor type 1, fibrinogen, and homocysteine. We defined CKD at follow-up (2005 to 2008) as estimated GFR (eGFR) Ͻ60 ml/min per 1.73 m 2 ; we defined MA as urine albumin-to-creatinine ratio Ն25 (women) or 17 (men) mg/g on spot urine samples. We identified a parsimonious set of markers related to outcomes adjusting for standard risk factors and baseline renal function, and we assessed their incremental predictive utility. During a mean 9.5-year follow-up, 213 participants developed CKD and 186 developed MA. In multivariable logistic regression models, the multi-marker panel was associated with incident CKD (P Ͻ 0.001) and MA (P ϭ 0.003). Serum homocysteine and aldosterone both were significantly associated with CKD incidence, and log-transformed aldosterone, BNP, and homocysteine were significantly associated with incident MA. Biomarkers improved risk prediction as measured by improvements in the c-statistics for both CKD and MA and by a 7% increase in net risk reclassification. In conclusion, circulating homocysteine, aldosterone, and BNP provide incremental information regarding risk for incident CKD and MA beyond traditional risk factors. Chronic kidney disease (CKD) affects nearly 26 million adults in the United States, which is nearly 13% of the adult population. 1 CKD is associated with metabolic abnormalities 2 and bone disease 3 and is also an important risk factor for peripheral vascular disease, 4,5 cardiovascular disease (CVD), 6 -8 stroke, 4 and allcause mortality. 9,10 Hypertension and diabetes are key risk factors for CKD 11 but do not fully identify individuals at risk for developing CKD. A recently developed algorithm for predicting incident CKD risk showed suboptimal discrimination, 12 underscoring the need to identify novel markers and use newer approaches for identifying high-risk individuals to prevent CKD in the community.Serum creatinine, as used in most GFR estimat-

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Correlates of N-Terminal Prohormone Brain Natriuretic Peptides in African Americans with Hypertensive Chronic Kidney Disease: The African American Study of Kidney Disease and Hypertension

Cited by 8 publications

References 53 publications

High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

Utility of Traditional Circulating and Imaging-Based Cardiac Biomarkers in Patients with Predialysis CKD

A Multi-Marker Approach to Predict Incident CKD and Microalbuminuria

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