Association of N-terminal pro-brain natriuretic peptide with contrast-induced acute kidney injury and long-term mortality in patients with heart failure and mid-range ejection fraction

Wang, Kun; Li, Hualong; Chen, Liling; Bei, Wei-jie; Lin, Kaiyang; Smyth, Brendan; Chen, Shiqun; Guo, Xiaosheng; Guo, Wei; Liu, Yuanhui; Chen, Peng-yuan; Chen, Jiyan; Chen, Kai-Hong; Liu, Yong; Tan, Ning

doi:10.1097/md.0000000000006259

Cited by 12 publications

(15 citation statements)

References 34 publications

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“…39 Higher NT-proBNP levels induce renal vasodilation, decrease renal blood flow, and lead to medullary ischemia and hypoxia by inhibiting sympathetic nerves, dilating blood vessels, and diuresis, which result in CIN. 40,41 Previous studies 42,43 have also shown that NT-proBNP is a risk factor for CIN in patients with ACS, which is consistent with our findings. Emergency PCI is an independent risk factor of CIN and may be related to the situation where patients who undergo emergency PCI lack preoperative preparations, such as corrected renal function.…”

Section: Discussionsupporting

confidence: 92%

Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis

et al. 2021

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Objective Contrast-induced nephropathy (CIN) is a serious complication in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). This study aimed to analyze the potential risk factors for CIN in patients undergoing PCI. Methods Patients with ACS who underwent PCI treatment from January 2017 to January 2020 were selected. The patients’ characteristics and medical information were collected and compared. Results A total of 1331 patients undergoing PCI were included. The incidence of CIN was 15.33%. Logistic regression analyses showed that a left ventricular ejection fraction ≤45% (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.10–7.36), serum creatinine levels ≤60 μmol/L (OR 3.03, 95% CI 1.21–5.57), age ≥65 years (OR 2.75, 95% CI 1.32–4.60), log N-terminal pro-B-type natriuretic peptide levels ≥2.5 pg/mL (OR 2.31, 95% CI 1.18–5.13), uric acid levels ≥350 μmol/L (OR 2.29, 95% CI 1.04–5.30), emergency percutaneous intervention (OR 1.35, 95% CI 0.34–3.12), and triglyceride levels ≤1.30 mmol/L (OR 1.10, 95% CI 0.01–2.27) were independent risk factors for CIN in patients who underwent PCI. Conclusions Early prevention is required to reduce the occurrence of CIN in patients who undergo PCI and have risk factors for CIN.

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Section: Discussionsupporting

confidence: 92%

Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis

et al. 2021

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“…Wang et al showed significant associations between NT-proBNP levels with CI-AKI and long-term mortality in patients with HFmrEF undergoing CAG/PCI 34 . Our study further confirmed that NT-proBNP levels were an independent risk factor for CI-AKI in the HFrEF, HFmrEF and HFpEF groups.…”

Section: Discussionmentioning

confidence: 99%

Association of the classification and severity of heart failure with the incidence of contrast-induced acute kidney injury

Lin

Shen

et al. 2021

Sci Rep

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Congestive heart failure (HF) is a known risk factor of contrast-induced acute kidney injury (CI-AKI). However, the relationship of the classification and severity of HF with CI-AKI remains under-explored. From January 2009 to April 2019, we recruited patients undergoing elective PCI who had complete pre- and post-operative creatinine data. According to the levels of ejection fraction (EF), HF was classified as HF with reduced EF (HFrEF) [EF < 40%], HF with mid-range EF (HFmrEF) [EF 40–49%] and HF with preserved EF (HFpEF) [EF ≥ 50%]. CI-AKI was defined as an increase of either 25% or 0.5 mg/dL (44.2 μmoI/L) in serum baseline creatinine level within 72 h following the administration of the contrast agent. A total of 3848 patients were included in the study; mean age 67 years old, 33.9% females, 48.1% with HF, and 16.9% with CI-AKI. In multivariate logistic regression analysis, HF was an independent risk factor for CI-AKI (OR 1.316, p value < 0.05). Among patients with HF, decreased levels of EF (OR 0.985, p value < 0.05) and elevated levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) (OR 1.168, p value < 0.05) were risk factors for CI-AKI. These results were consistent in subgroup analysis. Patients with HFrEF were more likely to develop CI-AKI than those with HFmrEF or HFpEF (OR 0.852, p value = 0.031). Additionally, lower levels of EF were risk factors for CI-AKI in the HFrEF and HFmrEF groups, but not in the HFpEF group. NT-proBNP was an independent risk factor for CI-AKI in the HFrEF, HFmrEF and HFpEF groups. Elevated levels of NT-proBNP are independent risk factors for CI-AKI irrespective of the classification of HF. Lower levels of EF were risk factors for CI-AKI in the HFrEF and HFmrEF groups, but not in the HFpEF group.

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“…Efficient and timely diagnosis is critical for reducing the mortality rates (35). NT-proBNP has long been used as a routine and rapid diagnostic method for patients with AHF (7-9); however, the use of NT-proBNP in diagnosing AHF in patients with renal insufficiency is controversial, since its level is markedly affected by the renal function (13)(14)(15)35). A significant proportion of patients exhibit functional impairment of both the heart and kidneys (36,37).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, patients with chronic kidney disease (CKD) present increased risks of accelerated atherosclerosis, nonfatal myocardial infarction, congestive heart failure (CHF), atrial and ventricular arrhythmias, and cardiac death (11). Although NT-proBNP is considered as a marker in AHF diagnosis, the diagnostic value of NT-proBNP in patients with renal insufficiency is still debated (12)(13)(14)(15). Therefore, a more effective plasma marker is required for the diagnosis of AHF patients with renal insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Adiponectin is valuable in the diagnosis of acute heart failure with renal insufficiency

Zhang

et al. 2018

Exp Ther Med

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Acute heart failure (AHF) is a major public health issue due to its high incidence and poor prognosis; thus, efficient and timely diagnosis is critical for improving the prognosis and lowering the mortality rate. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is widely used in the diagnosis of AHF; however, its efficacy is controversial in diagnosing AHF with renal insufficiency. There were numerous studies reporting the association of adiponectin (ADPN) and heart diseases. Therefore, the present study aimed to investigate whether ADPN is helpful in identifying AHF with renal insufficiency. A total of 407 participants (218 AHF patients and 189 controls) were enrolled into the current study. The plasma levels of ADPN and NT-proBNP were measured using a sandwich enzyme-linked immunosorbent assay and an electrochemiluminescence immunoassay, respectively. In addition, these levels were compared among the various New York Health Association classes, as well as the ischemic and non-ischemic AHF cases. The correlation between the two biomarkers and the renal function was analyzed by Spearman's correlation, while the diagnostic efficiency of ADPN and NT-proBNP was evaluated in AHF patients with and without renal insufficiency. The results revealed that NT-proBNP exhibited a higher diagnostic efficiency as compared with ADPN in patients without renal insufficiency [area under the receiver operating characteristic curve (AUC), 0.905 vs. 0.775]. By contrast, the ADPN presented a better diagnostic value in comparison with NT-proBNP in AHF with renal insufficiency (AUC, 0.872 vs. 0.828). Therefore, a combination of these two biomarkers may provide an excellent efficacy in the diagnosis of AHF with renal insufficiency (AUC, 0.904; sensitivity, 71.2%; specificity, 98.3%). In conclusion, ADPN is a valuable biomarker for diagnosing AHF, particularly in patients with impaired renal function.

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Association of N-terminal pro-brain natriuretic peptide with contrast-induced acute kidney injury and long-term mortality in patients with heart failure and mid-range ejection fraction

Cited by 12 publications

References 34 publications

Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis

Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis

Association of the classification and severity of heart failure with the incidence of contrast-induced acute kidney injury

Adiponectin is valuable in the diagnosis of acute heart failure with renal insufficiency

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