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Clinical Chemistry 53: 1264-1272, 2007. First published May 3, 2007; 10.1373/clinchem.2006.083170
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Right arrow Proteomics and Protein Markers
(Clinical Chemistry. 2007;53:1264-1272.)
© 2007 American Association for Clinical Chemistry, Inc.

Proteomics and Protein Markers

B-Type Natriuretic Peptide Concentrations Predict the Progression of Nondiabetic Chronic Kidney Disease: The Mild-to-Moderate Kidney Disease Study

Katharina-Susanne Spanaus1, Florian Kronenberg2, Eberhard Ritz3, Ralph Schlapbach4, Danilo Fliser5, Martin Hersberger1, Barbara Kollerits2, Paul König6, Arnold von Eckardstein1,a for the Mild-to-Moderate Kidney Disease Study Group

1 Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.
2 Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria.
3 Department of Internal Medicine, Division of Nephrology, Ruprecht-Karls-University, Heidelberg, Germany.
4 Functional Genomics Center, University of Zürich and ETH Zürich, Zürich, Switzerland.
5 Division of Nephrology, Department of Internal Medicine, Hannover Medical School, Hannover, Germany.
6 Innsbruck University Hospital, Department of Clinical Nephrology, Innsbruck, Austria.

aAddress correspondence to this author at: Institute for Clinical Chemistry, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Fax 41-1-255-4590; e-mail arnold.voneckardstein{at}usz.ch.

Background: Plasma concentrations of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are diagnostic and prognostic biomarkers of heart failure and are also increased in patients with chronic kidney disease (CKD). We examined the relevance of BNP and NT-proBNP as predictors of CKD progression.

Methods: Of 227 nondiabetic patients with mild-to-moderate renal insufficiency, 177 patients ages 18–65 years were followed in a prospective multicenter cohort study for a period of ≤7 years. CKD progression was assessed by recording renal endpoints, defined as doubling of baseline serum creatinine or end-stage renal disease (ESRD) requiring renal replacement therapy.

Results: BNP and NT-proBNP were significantly higher among 65 patients who reached the combined renal endpoint than among the 112 who did not [median (interquartile range) 61 (27–98) ng/L vs 39 (20–70) ng/L, P = 0.023, for BNP; 320 (117–745) ng/L vs 84 (44–176) ng/L, P <0.001, for NT-proBNP)]. Each increment of 1 SD in log-transformed BNP and NT-proBNP increased the risk of CKD progression by hazard ratios of 1.38 (95% CI 1.09–1.76, P = 0.009) and 2.28 (1.76–2.95, P <0.001), respectively. After adjustment for other established prognostic factors of CKD progression, NT-proBNP but not BNP remained a significant independent predictor of the combined renal endpoint.

Conclusions: Increased BNP and NT-proBNP concentrations indicate an increased risk for accelerated progression of CKD to ESRD and may prove to be valuable biomarkers for the assessment of prognosis in patients with CKD.




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