Renal Clearance of B-Type Natriuretic Peptide and Amino Terminal Pro-B-Type Natriuretic Peptide

Kimmenade, Roland R.J. van; Januzzi, James L.; Bakker, J.; Houben, A. J. H. M.; Rennenberg, Roger J M W; Crijns, Harry J.G.M.; Dieijen-Visser, Marja P. van; Leeuw, Peter W. de; Pinto, Yigal M.

doi:10.1016/j.jacc.2008.11.032

Cited by 159 publications

(133 citation statements)

References 49 publications

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“…Recent reports showed that NT-proBNP and BNP are equally dependent on renal function for clearance, suggesting also a saturable clearance mechanism for NT-proBNP degradation independent of glomerular filtration, yet unknown (10). NTproBNP has a longer half-life (70Á120 min) that may allow for greater accumulation and potentially greater sensitivity in detecting more subtle structural and functional changes (9,10). In our population, NT-proBNP was directly correlated with age, hypertension, diabetes and smoking and inversely correlated with eCrCl and weight, confirming previous studies, particularly on eCrCl and obesity (11,12).…”

Section: Discussionsupporting

confidence: 86%

Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?

et al. 2009

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Background: NT-proBNP has prognostic implications in heart failure. In acute coronary syndromes (ACS) setting, the prognostic significance of NT-proBNP is being sought. We studied short-term prognostic impact of admission NT-proBNP in patients admitted for ACS and in association with GRACE risk score (GRS). Methods and Results: We studied 1035 patients admitted with ACS. Patients were divided in quartiles according to NT-proBNP levels on admission: Q1 B180 pg/ ml; Q2 180Á691 pg/ml; Q3 696Á2664 pg/ml; Q4 2698Á35 000 pg/ml. Groups were compared in terms of short-term allcause mortality. Patients with higher NT-proBNP had worst GRS on admission. They also received less aggressive treatment. In-hospital mortality was 0.8%, 3.0%, 5.8% and 12.8% (P B0.001) and 30-day mortality 1.6%, 4.6%, 6.5% and 16.7% (P B0.001) respectively. In multivariate logistic regression analysis, NT-proBNP is an independent predictor of inhospital (OR 2.35; 95% CI: 1.12Á4.93, P 00.022) and 30-day mortality (OR 2.20; 95% CI: 1.17Á4.12, P 00.014). However, NT-proBNP does not add any incremental benefit to GRS for prediction of outcome by ROC curve analysis. Conclusions: NT-proBNP is an independent predictor of in-hospital and 30-day mortality after ACS, independently of left ventricular function, but does not increase the prognostic accuracy of GRS.

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Section: Discussionsupporting

confidence: 86%

Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?

et al. 2009

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“…In addition, NT-BNP-76 is more stable in vitro, and the higher concentration makes it easier to measure than BNP-32 (29). A different effect of renal elimination between BNP-32 and NT-BNP-76 has been described (30) but not confirmed by a study of the dependence of NT-BNP-76 and BNP-32 on renal clearance (31). Further studies of both markers simultaneously are required to better elucidate the factors causing the differential increase in their concentrations.…”

Section: Discussionmentioning

confidence: 99%

Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant

Roberts

Hare

Sikaris³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives B-type natriuretic peptide (BNP) concentration predicts outcome in patients undergoing dialysis. Because survival and cardiovascular risk change across the CKD continuum, serial changes in BNP were compared in patients at different CKD stages and after kidney transplantation.Design, setting, participants, & measurements Patients with CKD stages 3 and 4 (CKD 3-4), dialysis patients, and kidney transplant recipients (KTRs) from one center had two measurements of BNP taken a median of 161 days apart in 2003-2004 and were followed until July 2012. Both BNP-32 (Triage BNP; Biosite Diagnostics) and NT-BNP-76 (proBNP; Roche Diagnostics) were assayed. The interaction between change in log-transformed BNP concentration over time and patient group was tested by fitting regression models on panel data with random effects. Survival after the second measurement was compared by tertile of change in BNP.Results Patients with CKD 3-4 (n=48), dialysis patients (n=102), and KTRs (n=73) were followed for a median of 5.7, 4.8, and 5.9 years, respectively. The interaction between patient group and BNP measurements over time was significant for NT-BNP-76 (P,0.001) and BNP-32 (P,0.01). Median NT-BNP-76 increased in dialysis patients and those with CKD 3-4 from 3850 pg/ml (interquartile range [IQR], 1776-12,323 pg/ml) to 18,830 pg/ml (IQR, 6114-61,009 pg/ml; P,0.001) and from 698 pg/ml (IQR, 283-2922 pg/ml) to 2529 pg/ml (IQR, 347-9277 pg/ml; P=0.002), respectively. Change was not significant for KTRs or comparisons made with BNP-32. Survival rate was significantly lower for patients with the highest tertile of change in NT-BNP-76 among patients with CKD 3-4 (P=0.02), but not in the dialysis or KTR groups. In 11 patients who received a kidney transplant during the study, median NT-BNP-76 decreased from 9607 pg/ml (IQR, 2292-31,282 pg/ml) to 457 pg/ml (IQR, 203-863 pg/ml) after transplant (P,0.01).Conclusions The temporal trajectory of BNP differs between dialysis patients and those with CKD 3-4 and KTRs. This has important implications for the development of BNP-guided management strategies in CKD.

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“…Levels of NT-proBNP and TnT are commonly elevated in patients with reduced kidney function (15)(16)(17)(18)(19)(20)(21), resulting from multiple physiologic stresses, including extracellular volume expansion, LVH, myocardial ischemia, and possibly, reduced renal clearance (16,20,(22)(23)(24). Most studies to date have primarily focused on the association between NT-proBNP and TnT and cardiovascular and/or all-cause death.…”

Section: Introductionmentioning

confidence: 99%

NT-ProBNP and Troponin T and Risk of Rapid Kidney Function Decline and Incident CKD in Elderly Adults

Bansal

Katz

Dalrymple

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Elevations in N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T are associated with poor cardiovascular outcomes. Whether elevations in these cardiac biomarkers are associated with decline in kidney function was evaluated.Design, setting, participants, & measurements N-terminal pro-B-type natriuretic peptide and troponin T were measured at baseline in 3752 participants free of heart failure in the Cardiovascular Health Study. eGFR was determined from the Chronic Kidney Disease Epidemiology Collaboration equation using serum cystatin C. Rapid decline in kidney function was defined as decline in serum cystatin C eGFR$30%, and incident CKD was defined as the onset of serum cystatin C eGFR,60 among those without CKD at baseline (n=2786). Cox regression models were used to examine the associations of each biomarker with kidney function decline adjusting for demographics, baseline serum cystatin C eGFR, diabetes, and other CKD risk factors.Results In total, 503 participants had rapid decline in serum cystatin C eGFR over a mean follow-up time of 6.41 (1.81) years, and 685 participants developed incident CKD over a mean follow-up time of 6.41 (1.74) years. Participants in the highest quartile of N-terminal pro-B-type natriuretic peptide (.237 pg/ml) had an 67% higher risk of rapid decline and 38% higher adjusted risk of incident CKD compared with participants in the lowest quartile (adjusted hazard ratio for serum cystatin C eGFR rapid decline, 1.67; 95% confidence interval, 1.25 to 2.23; hazard ratio for incident CKD, 1.38; 95% confidence interval, 1.08 to 1.76). Participants in the highest category of troponin T (.10.58 pg/ml) had 80% greater risk of rapid decline compared with participants in the lowest category (adjusted hazard ratio, 1.80; 95% confidence interval, 1.35 to 2.40). The association of troponin T with incident CKD was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.92 to 1.50).Conclusions Elevated N-terminal pro-B-type natriuretic peptide and troponin T are associated with rapid decline of kidney function and incident CKD. Additional studies are needed to evaluate the mechanisms that may explain this association.

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Renal Clearance of B-Type Natriuretic Peptide and Amino Terminal Pro-B-Type Natriuretic Peptide

Abstract: Contrary to widespread belief (but in line with the renal physiology of SMWP), BNP and NT-proBNP are equally dependent on renal function for their clearance.

Cited by 159 publications

References 49 publications

Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?

Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?

Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant

NT-ProBNP and Troponin T and Risk of Rapid Kidney Function Decline and Incident CKD in Elderly Adults

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