Impact of Renal Disease on Natriuretic Peptide Testing for Diagnosing Decompensated Heart Failure and Predicting Mortality

deFilippi, Christopher R.; Seliger, Stephen L.; Maynard, Susan; Christenson, Robert H.

doi:10.1373/clinchem.2006.084533

Cited by 92 publications

(70 citation statements)

References 25 publications

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“…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. 31 In a study of 104 patients with CKD but without HF, elevated BNP was associated with a 6-fold higher rate of subsequent HF.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…We have recently shown that plasma BNP concentrations strongly reflect LV EDWS in HF patients with normal creatinine concentrations, and this relationship was more robust than any other parameter previously reported (11 ). Although several studies have already demonstrated the association between BNP and renal function in patients with HF or without HF, hemodynamic factors were not adequately considered in the analysis (23)(24)(25). Accordingly, we performed this study in a wide spectrum of HF patients with a concomitant analysis of EDWS and showed that both EDWS and renal dysfunction may contribute to the increased BNP concentrations independently in this setting.…”

Section: Discussionmentioning

confidence: 82%

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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“…As reported previously for this cohort of patients (8 ), all patient charts were reviewed by staff, and demographics, serum creatinine, cardiovascular risk factors, cardiovascular history, cardiovascular test results, medications, and discharge codes [International Classification of Diseases, Ninth Revision (ICD-9); http:// www.cdc.gov/nchs/icd/icd9.htm] were abstracted into a case report form. We defined prior coronary artery disease as a history of myocardial infarction or revascularization or an ischemic cardiomyopathy; history of HF as a prior diagnosis, or if uncertain, by the use of loop diuretics in the setting of a known left ventricular ejection fraction (LVEF) Յ40%.…”

Section: Data Collection and Hf Adjudicationmentioning

confidence: 99%

Impact of Increased Body Mass Index on Accuracy of B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP for Diagnosis of Decompensated Heart Failure and Prediction of All-Cause Mortality

Christenson

Azzazy

Duh³

et al. 2010

Clinical Chemistry

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Background: BNP and N-terminal proBNP (NT-proBNP) concentrations may be depressed in patients with increased body mass index (BMI). Whether increased BMI affects accuracy of these biomarkers for diagnosing decompensated heart failure (HF) and predicting outcomes is unknown. Methods: We measured BNP and NT-proBNP in 685 patients with possible decompensated HF in a free-living community population subdivided by BMI as obese, overweight, and normal weight. HF diagnosis was adjudicated by a cardiologist blinded to BNP and NT-proBNP results. We tabulated all-cause mortality over a median follow-up of 401 days and assessed marker accuracy for HF diagnosis and mortality by ROC analysis. Results: Of the 685 patients, 40.9% were obese (n = 280), 28.2% were overweight (n = 193), and 30.9% had normal BMI (n = 212). Obese patients had lower BNP and NT-proBNP compared with overweight or normal-weight individuals (P < 0.001) and decreased mortality compared with normal-weight individuals (P < 0.001). Both biomarkers added significantly to a multivariate logistic regression model for diagnosis of decompensated HF across BMI categories. NT-proBNP outperformed BNP for predicting all-cause mortality in normal-weight individuals (χ2 for BNP = 6.4, P = 0.09; χ2 for NT-proBNP = 16.5, P < 0.001). Multivariate regression showed that both biomarkers remained significant predictors of decompensated HF diagnosis in each BMI subgroup. Conclusions: In this study population, obese patients had significantly lower BNP and NT-proBNP that reflected lower mortality. BNP and NT-proBNP can be used in all BMI groups for decompensated HF diagnosis, although BMI-specific cutpoints may be necessary to optimize sensitivity.

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Impact of Renal Disease on Natriuretic Peptide Testing for Diagnosing Decompensated Heart Failure and Predicting Mortality

Cited by 92 publications

References 25 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

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

Impact of Increased Body Mass Index on Accuracy of B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP for Diagnosis of Decompensated Heart Failure and Prediction of All-Cause Mortality

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