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Clinical Chemistry 55: 1271-1273, 2009. First published May 21, 2009; 10.1373/clinchem.2009.128157
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(Clinical Chemistry. 2009;55:1271-1273.)
© 2009 American Association for Clinical Chemistry, Inc.

Editorials

B-Type Natriuretic Peptide (BNP)/NT-proBNP and Renal Function: Is the Controversy Over?

Christopher R. deFilippi1,a and Robert H. Christenson2

1 Division of Cardilogy and2 Department of Pathology, University of Maryland School of Medicine, Baltimore, MD.

aAddress correspondence to this author at: Division of Cardiology, University of Maryland School of Medicine, G3K63, 22 South Greene St., Baltimore, MD 21201. Fax 410-328-6956; e-mail cdefilip@medicine.umaryland.edu.

The first 20% of the full text of this article appears below.

A decade ago, controversy surrounded the observation of increased cardiac troponin concentrations in asymptomatic renal disease patients, with one assay claiming better specificity and another better prognostic potential. This controversy is largely resolved now, with availability of more outcome data, improved low-end sensitivity of the assays, and a general recognition that renal disease was only one cause, albeit an important one, of myocardial injury in the absence of an acute coronary syndrome (1). It should come as little surprise, then, that soon after the introduction of commercial assays for B-type natriuretic peptide (BNP)1 and amino-terminal pro-BNP (NT-proBNP) and the publication of seminal studies for their diagnostic application in patients presenting with dyspnea of uncertain etiology, there has been much debate over the interpretation and significance of these tests in patients with impaired renal function (2)(3).

Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, is a common condition with multiple etiologies that affects an estimated 8.3 million Americans and is found in 33% to 56% of patients with heart failure (4). The use of either BNP or NT-proBNP to diagnose decompensated heart failure in dyspnea patients with concomitant moderate renal disease (eGFR 30–59 mL/min/1.73 m2) is generally accepted clinically. When comparing the diagnostic accuracy of these tests in individuals with and without impaired renal function, only mildly diminished accuracy is observed in renal disease, as long as a modestly increased optimal cutoff is used for BNP or age-specific cutoffs for NT-proBNP (5)(6). The caveat is that concentrations of BNP and NT-proBNP are typically increased to a much greater extent (NT-proBNP more so than . . . [Full Text of this Article]


decreased renal clearance?


increased cardiovascular pathology?




The following articles in journals at HighWire Press have cited this article:


Home page
 HeartHome page
B Dieplinger, A Gegenhuber, M Haltmayer, and T Mueller
The authors' reply:
Heart, October 1, 2009; 95(19): 1627 - 1627.
[Full Text] [PDF]


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