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Received on December 13, 2006
Accepted on May 30, 2007
General Clinical Chemistry |
1 Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD
2 Carolinas Medical Center, Charlotte, NC
* To whom correspondence should be addressed. E-mail: cdefilip{at}medicine.umaryland.edu.
Background: Concomitant occurrence of kidney disease (KD) and heart failure (HF) is common and associated with poor outcomes. Natriuretic peptide studies have typically excluded many individuals with KD. We compared the accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for diagnosing decompensated HF and predicting mortality across the spectrum of renal function.
Methods: BNP and NT-proBNP were prospectively measured in a cohort of 831 dyspnea patients. KD was defined as an estimated glomerular filtration rate <60 mL · min-1 · (1.73 m2)-1. The accuracy and predictive value of each test for diagnosing decompensated HF and predicting all-cause 1-year mortality were assessed by ROC area under the curve (AUC) and multivariate regression analysis.
Results: Among the 831 dyspnea patients, 393 (47%) had KD. The diagnostic accuracies of BNP and NT-proBNP in detecting decompensated HF were similar to each other in patients without KD (AUC 0.75 vs 0.74, respectively; P = 0.60) and in patients with KD (AUC 0.68 vs 0.66; P = 0.10). One-year mortality rates were 36.3% and 19.0% in those with and without KD, respectively (P <0.001). Progressively higher BNP and NT-proBNP concentrations remained predictive of increased mortality in KD patients. Compared with the lowest quartile, quartile 4 of BNP had an adjusted hazards ratio (HR) of 2.6 (95% CI 1.4-4.8; P = 0.004 for trend) and NT-proBNP quartile 4 had an HR of 4.5 (95% CI 2.0-10.2; P <0.001 for trend). Only NT-proBNP remained a predictor of death after adjustment for clinical confounders and the other natriuretic peptide marker.
Conclusions: NT-proBNP and BNP are equivalent predictors of decompensated HF across a spectrum of renal function, but NT-proBNP is a superior predictor of mortality.
The following articles in journals at HighWire Press have cited this article:
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  S. C. Palmer, T. G. Yandle, M. G. Nicholls, C. M. Frampton, and A. M. Richards Regional clearance of amino-terminal pro-brain natriuretic peptide from human plasma Eur J Heart Fail, September 1, 2009; 11(9): 832 - 839. [Abstract] [Full Text] [PDF]
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 V. HAJJAR and M. J. SCHREIBER JR. Q: Does measuring natriuretic peptides have a role in patients with chronic kidney disease? Cleveland Clinic Journal of Medicine, August 1, 2009; 76(8): 476 - 478. [Full Text] [PDF]
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 G. C.M. Linssen, K. Damman, H. L. Hillege, G. Navis, D. J. van Veldhuisen, and A. A. Voors Urinary N-Terminal Prohormone Brain Natriuretic Peptide Excretion in Patients With Chronic Heart Failure Circulation, July 7, 2009; 120(1): 35 - 41. [Abstract] [Full Text] [PDF]
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 S. Niizuma, Y. Iwanaga, T. Yahata, Y. Tamaki, Y. Goto, H. Nakahama, and S. Miyazaki Impact of Left Ventricular End-Diastolic Wall Stress on Plasma B-Type Natriuretic Peptide in Heart Failure with Chronic Kidney Disease and End-Stage Renal Disease Clin. Chem., July 1, 2009; 55(7): 1347 - 1353. [Abstract] [Full Text] [PDF]
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C. R. deFilippi and R. H. Christenson B-Type Natriuretic Peptide (BNP)/NT-proBNP and Renal Function: Is the Controversy Over? Clin. Chem., July 1, 2009; 55(7): 1271 - 1273. [Full Text] [PDF]
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 S. C. Palmer and A. M. Richards Does renal clearance differ between the B-type natriuretic peptides (BNP versus NT-proBNP)? J. Am. Coll. Cardiol., March 10, 2009; 53(10): 891 - 892. [Full Text] [PDF]
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K. B. Shah, W. J. Kop, R. H. Christenson, D. B. Diercks, D. Kuo, S. Henderson, K. Hanson, M. R. Mehra, and C. R. deFilippi Lack of Diagnostic and Prognostic Utility of Circulating Plasma Myeloperoxidase Concentrations in Patients Presenting with Dyspnea Clin. Chem., January 1, 2009; 55(1): 59 - 67. [Abstract] [Full Text] [PDF]
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 S. Vickery, M. C. Webb, C. P. Price, R. I. John, N. A. Abbas, and E. J. Lamb Prognostic value of cardiac biomarkers for death in a non-dialysis chronic kidney disease population Nephrol. Dial. Transplant., November 1, 2008; 23(11): 3546 - 3553. [Abstract] [Full Text] [PDF]
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