Prognostic value of B-type natriuretic peptide and its amino-terminal proBNP fragment for cardiovascular events with stratification by renal function

Horii, Manabu; Matsumoto, Takaki; Uemura, Shiro; Yu, Simon C.H.; Takitsume, Akihiro; Ueda, Tomoya; Nakagawa, Hitoshi; Nishida, Taku; Soeda, Tsunenari; Okayama, Satoshi; Somekawa, Satoshi; Ishigami, Kousei; Takeda, Yukiji; Kawata, Hiroyuki; Kawakami, Rika; Saito, Yoshihiko

doi:10.1016/j.jjcc.2013.01.015

Cited by 54 publications

(70 citation statements)

References 22 publications

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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%

“…In a Japanese study, both BNP and NT-pro-BNP were associated with death and the composite of death and CV events. On the basis of the areas under the curve, the authors concluded that NT-pro-BNP may be a superior marker to BNP for composite events in patients with CKD stages 4 and 5 (versus stages 1-3), although a formal statistical test was not used to determine whether the curves significantly differed (26). Among the African American Study of Kidney Disease and Hypertension cohort, those with elevated NT-pro-BNP had a four times higher hazard for CV events than those with undetectable levels (Table 2) (35).…”

Section: Bnp and Hard Outcomes In Ckdmentioning

confidence: 99%

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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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Section: Bnp and Nt-pro-bnp In Ckdmentioning

confidence: 99%

Section: Bnp and Hard Outcomes 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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“…As patients with CKD are known to be highly susceptible to HF, BNP-guided management in daily clinical practice for CKD patients is quite relevant and may reduce the possibility of future HF or CVEs, leading to improved survival. Previous studies have shown that high BNP levels were associated with all- cause and cardiovascular mortality or CVEs in CKD patients; however, almost of the study subjects were on chronic dialysis [10][11][12] or in early stage CKD (stages 2-3b) because of a community-based or a cardiovascular disease cohort [15,16]. Furthermore, the study for advanced CKD patients had a small sample size [17].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there has been growing interest in the use of BNP for predicting outcomes in CKD patients on chronic dialysis [10][11][12]; however, the use of BNP has not been fully clarified in predialysis CKD patients [13,14]. In previous studies involving predialysis CKD patients, early CKD patients were mainly included and these studies were conducted in non-nephrological care settings because of a community-based cohort or a cardiovascular disease cohort [15,16] and comprised a relatively small sample size, especially for CKD stages 4-5 [17].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Asymptomatic Brain Natriuretic Peptide Elevation at Nephrology Referral in Patients with Chronic Kidney Disease

et al. 2018

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Background: It is unclear whether asymptomatic elevation of brain natriuretic peptide (BNP) is associated with cardiovascular events (CVEs) or heart failure (HF) in predialysis chronic kidney disease (CKD) patients. Methods: We measured BNP in 482 asymptomatic predialysis patients with CKD stages 2–5 at nephrology referral between August 2004 and October 2010, and followed them prospectively to investigate the prognostic significance of BNP using Cox models and receiver operating characteristic (ROC) analyses. The primary composite end point was the time to death or the first nonfatal CVEs. Secondary end points included CVEs including sudden death, HF and all-cause death. Results: The median age was 67 years (male, 67.4%; diabetic nephropathy, 33.4%), and estimated glomerular filtration rate was 20.1 mL/min/1.73 m². The primary end point occurred in 92 patients. CVEs including sudden death, HF and all-cause death occurred in 66, 35, and 54 patients, respectively during a median follow-up period of 37.7 months. Multivariate analyses showed that BNP level was significantly associated with the primary end point (hazard ratio [HR] 1.241; 95% CI 1.020–1.511; p = 0.031), CVEs (HR 1.337; 95% CI 1.067–1.675; p = 0.012) and HF (HR 1.489; 95% CI 1.059–2.091; p = 0.022), but not associated with all-cause death (HR 1.081; 95% CI 0.829–1.410; p = 0.565). The ROC curves showed that the optimal predictive BNP levels for the primary end point, CVEs and HF were 92.5, 127.0, and 274.6 (pg/mL) respectively. Conclusion: Asymptomatic elevation of BNP is strongly predictive for CVEs and HF, which might help to integrate cardio-renal risk stratification in predialysis CKD patients.

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“…The plasma BNP levels increase in patients with HF, and various levels are associated with specific New York Heart Association (NYHA) classes (10). Thus, BNP is helpful for diagnosing and assessing the severity of HF as well as reflecting the prognosis of patients with HF (11,12).…”

Section: Introductionmentioning

confidence: 99%

The Optimal Cut-off Value of Plasma BNP to Differentiate Heart Failure in the Emergency Department in Japanese Patients with Dyspnea

et al. 2015

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Objective In the emergency department, it is sometimes difficult to differentiate heart failure (HF) from other diseases (e.g., respiratory diseases) in patients who develop dyspnea. The plasma B-type natriuretic peptide (BNP) levels increase in patients with HF, and various levels are associated with specific New York Heart Association classes. Although the diagnosis of HF should not be made based only on the plasma BNP levels, the identification of a cut-off value for BNP to diagnose HF would be helpful. Methods Patients admitted to the emergency department of our hospital with dyspnea between January 2010 and December 2011 were retrospectively reviewed. The patients whose estimated glomerular filtration rate was less than 30 mL/min/1.73 m 2 were excluded. Patients were divided into two groups: those with HF (n=131) and those without HF (n=138). The cut-off value for BNP was determined by the receiver-operating characteristic curve. Results The area under the curve of this curve was 0.934. The optimal cut-off point for detection of HF was 234 pg/mL. The sensitivity and specificity were 87.0% and 85.5%, respectively. The fifth and 95th percentiles of the HF group were 132.2 and 2,420.8 pg/mL, respectively. Those of the non-HF group were 9.7 and 430.2 pg/mL, respectively. Conclusion Our study suggests that a plasma BNP level cut-off value of 234 pg/mL can be used to detect HF in the emergency department.

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Prognostic value of B-type natriuretic peptide and its amino-terminal proBNP fragment for cardiovascular events with stratification by renal function

Abstract: Both BNP and NT-proBNP are useful biomarkers for mortality and cardiovascular events, but NT-proBNP may be superior to BNP for CKD stages 4-5.

Cited by 54 publications

References 22 publications

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

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

Prognostic Significance of Asymptomatic Brain Natriuretic Peptide Elevation at Nephrology Referral in Patients with Chronic Kidney Disease

The Optimal Cut-off Value of Plasma BNP to Differentiate Heart Failure in the Emergency Department in Japanese Patients with Dyspnea

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