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N-terminal pro-brain natriuretic peptide, kidney disease and outcome in patients with chronic heart failure.
J Heart Lung Transplant. 2006 Sep; 25(9):1135-41.JH

Abstract

BACKGROUND

In patients with chronic heart failure (CHF), N-terminal pro-brain natriuretic peptide (NT-proBNP) provides relevant prognostic information, but its usefulness in the presence of kidney disease has been questioned.

METHODS

We prospectively enrolled 142 patients with stable CHF and a wide spectrum of renal function (estimated glomerular filtration rates [eGFRs] ranging from 17.1 to 100.3 ml/min/1.73 m2). Chronic kidney disease, defined as eGFR < 60 ml/min/1.73 m2, was present in 63 patients (44%). NT-proBNP measurements were carried out on a bench-top analyzer (Elecsys 2010). Cardiac death or urgent cardiac transplantation were considered as a combined study end-point.

RESULTS

During a follow-up of 383 +/- 237 days, 19 patients underwent a cardiac event (cardiac death, n = 17; urgent cardiac transplantation, n = 2). By multivariate Cox analysis, including clinical and laboratory variables, NT-proBNP and serum hemoglobin were independent prognostic predictors. In patients with NT-proBNP > 1,129 pg/ml, outcome was significantly worse compared to patients with NT-proBNP < 1,129 pg/ml (event-free survival rate 67% vs 94% in those with NT-proBNP < 1,129 pg/ml, p = 0.001). By linear regression analysis, NT-proBNP levels were related to New York Heart Association (NYHA) functional class (R = 0.41, p < 0.001), and inversely related to eGFR (R = -0.29, p = 0.001) and to left ventricular ejection fraction (R = -0.43, p < 0.001).

CONCLUSIONS

In CHF patients with and without kidney disease, NT-proBNP provides independent prognostic information. In such patients, NT-proBNP levels are not only reflective of a reduced clearance (i.e., a lower eGFR) but also of the severity of the underlying structural heart disease.

Authors+Show Affiliations

Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany. bruchc@uni-muenster.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

16962477

Citation

Bruch, Christian, et al. "N-terminal Pro-brain Natriuretic Peptide, Kidney Disease and Outcome in Patients With Chronic Heart Failure." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 25, no. 9, 2006, pp. 1135-41.
Bruch C, Reinecke H, Stypmann J, et al. N-terminal pro-brain natriuretic peptide, kidney disease and outcome in patients with chronic heart failure. J Heart Lung Transplant. 2006;25(9):1135-41.
Bruch, C., Reinecke, H., Stypmann, J., Rothenburger, M., Schmid, C., Breithardt, G., Wichter, T., & Gradaus, R. (2006). N-terminal pro-brain natriuretic peptide, kidney disease and outcome in patients with chronic heart failure. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 25(9), 1135-41.
Bruch C, et al. N-terminal Pro-brain Natriuretic Peptide, Kidney Disease and Outcome in Patients With Chronic Heart Failure. J Heart Lung Transplant. 2006;25(9):1135-41. PubMed PMID: 16962477.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - N-terminal pro-brain natriuretic peptide, kidney disease and outcome in patients with chronic heart failure. AU - Bruch,Christian, AU - Reinecke,Holger, AU - Stypmann,Jörg, AU - Rothenburger,Markus, AU - Schmid,Christof, AU - Breithardt,Günter, AU - Wichter,Thomas, AU - Gradaus,Rainer, Y1 - 2006/08/02/ PY - 2006/03/13/received PY - 2006/04/30/revised PY - 2006/05/15/accepted PY - 2006/9/12/pubmed PY - 2006/10/25/medline PY - 2006/9/12/entrez SP - 1135 EP - 41 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J Heart Lung Transplant VL - 25 IS - 9 N2 - BACKGROUND: In patients with chronic heart failure (CHF), N-terminal pro-brain natriuretic peptide (NT-proBNP) provides relevant prognostic information, but its usefulness in the presence of kidney disease has been questioned. METHODS: We prospectively enrolled 142 patients with stable CHF and a wide spectrum of renal function (estimated glomerular filtration rates [eGFRs] ranging from 17.1 to 100.3 ml/min/1.73 m2). Chronic kidney disease, defined as eGFR < 60 ml/min/1.73 m2, was present in 63 patients (44%). NT-proBNP measurements were carried out on a bench-top analyzer (Elecsys 2010). Cardiac death or urgent cardiac transplantation were considered as a combined study end-point. RESULTS: During a follow-up of 383 +/- 237 days, 19 patients underwent a cardiac event (cardiac death, n = 17; urgent cardiac transplantation, n = 2). By multivariate Cox analysis, including clinical and laboratory variables, NT-proBNP and serum hemoglobin were independent prognostic predictors. In patients with NT-proBNP > 1,129 pg/ml, outcome was significantly worse compared to patients with NT-proBNP < 1,129 pg/ml (event-free survival rate 67% vs 94% in those with NT-proBNP < 1,129 pg/ml, p = 0.001). By linear regression analysis, NT-proBNP levels were related to New York Heart Association (NYHA) functional class (R = 0.41, p < 0.001), and inversely related to eGFR (R = -0.29, p = 0.001) and to left ventricular ejection fraction (R = -0.43, p < 0.001). CONCLUSIONS: In CHF patients with and without kidney disease, NT-proBNP provides independent prognostic information. In such patients, NT-proBNP levels are not only reflective of a reduced clearance (i.e., a lower eGFR) but also of the severity of the underlying structural heart disease. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/16962477/N_terminal_pro_brain_natriuretic_peptide_kidney_disease_and_outcome_in_patients_with_chronic_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(06)00403-7 DB - PRIME DP - Unbound Medicine ER -