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Received on November 15, 2006
Accepted on April 5, 2007
Proteomics and Protein Markers |
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
* To whom correspondence should be addressed. 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.
The following articles in journals at HighWire Press have cited this article:
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  M. Emdin, S. Vittorini, C. Passino, and A. Clerico Old and new biomarkers of heart failure Eur J Heart Fail, April 1, 2009; 11(4): 331 - 335. [Abstract] [Full Text] [PDF]
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 C. Ronco, M. Haapio, A. A. House, N. Anavekar, and R. Bellomo Cardiorenal Syndrome J. Am. Coll. Cardiol., November 4, 2008; 52(19): 1527 - 1539. [Abstract] [Full Text] [PDF]
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 B.C. Astor, S. Yi, L. Hiremath, T. Corbin, V. Pogue, B. Wilkening, G. Peterson, J. Lewis, J.P. Lash, F. Van Lente, et al. N-Terminal Prohormone Brain Natriuretic Peptide as a Predictor of Cardiovascular Disease and Mortality in Blacks With Hypertensive Kidney Disease: The African American Study of Kidney Disease and Hypertension (AASK) Circulation, April 1, 2008; 117(13): 1685 - 1692. [Abstract] [Full Text] [PDF]
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 P.D. Giles, P.B. Rylance, and D.C. Crothers New results from the Modification of Diet in Renal Disease study: the importance of clinical outcomes in test strategies for early chronic kidney disease QJM, February 1, 2008; 101(2): 155 - 158. [Abstract] [Full Text] [PDF]
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