Comparison of N‐terminal proB‐type natriuretic peptide levels at different stages of visceral leishmaniosis and in patients with chronic kidney disease

Abstract

N-terminal proB-type natriuretic peptide (NT-proBNP) may be a useful marker in canine leishmaniosis (CanL). The aim was to compare NT-proBNP in dogs at different LeishVet stages of CanL and with idiopathic chronic kidney disease (CKD). Dogs diagnosed with CanL or CKD and a group of healthy dogs were included (group A, five normal dogs; group B, six dogs LeishVet 1–2; group C, 13 dogs LeishVet 3–4; group D, six dogs with CKD). NT-proBNP was higher (P<0.001) in group C (7.616 pmol/l, interquartile range (IQR) 3537–10,000 pmol/l) than in group A (293 pmol/l, IQR 257–373), group B (388.5 pmol/l, IQR 324–793) and group D (740 pmol/l, IQR 557–962 pmol/l). International Renal Interest Society (IRIS) kidney stage was not different between groups C and D or between groups A and B, but was different within all the rest of the group comparisons (P<0.001). In group C all dogs had echocardiographic increase in left ventricular mass index. NT-proBNP had negative correlation with haematocrit (P<0.001, r=0.749) and positive correlation with systemic blood pressure (P<0.001, r=0.728). NT-proBNP is consistently elevated in dogs with advanced CanL and is strongly correlated with the degree of systemic hypertension and anaemia. Moreover, dogs with advanced CanL exhibit increase in left ventricular mass. NT-proBNP may however be a less desirable cardiac marker as unlike cardiac troponin I it is often not elevated at earlier stages of CanL.

Association of myocardial parasitic load with cardiac biomarkers and other selected variables in 10 dogs with advanced Canine Leishmaniasis

“…Chronic kidney disease is known to be associated with increase NT‐proBNP 28,29 but the values in CanL are significantly higher than those of dogs with idiopathic chronic kidney at similar IRIS stage, 11 which potentially might support its exploration as an independent marker in CanL. However, NT‐proBNP has shown to be less consistently elevated than cTnI at early stages of the disease and to be strongly associated with secondary processes such as the degree of systemic arterial hypertension and anaemia 11 . The complex and variable interrelations in advanced CanL among several factors such as ventricular thickening, increase in peripheral vascular resistance and volume status, and the resultant ventricular stress, are likely to determine NT‐proBNP release.…”

“…The cardiac involvement in CanL has led to research into the potential clinical or research use of cardiac biomarkers in this disease 4,5,10,11 . The main markers currently used for the classification of CanL comprise a subjective evaluation of clinical signs, serology and protein electrophoresis findings, and routine kidney markers such as urine protein/creatinine ratio (UPC) and serum creatinine levels 3,12 .…”

“…A specific cardiac biomarker may also function as a surrogate for the severity of the cardiac parasitic load and the degree of cardiac involvement in any particular individual with CanL. Several studies have evaluated the different aspects of cardiac biomarkers Troponin I (cTnI) and N‐terminal proB‐type natriuretic peptide (NT‐proBNP) in CanL 4,5,10,11 . The cardiac biomarker cTnI, a marker of myocardial damage 13 has been shown to be elevated in CanL from early stages and to increase gradually as the disease progresses 4,5 .…”

“…NT‐proBNP, a marker of acute and chronic increments of ventricular wall stress, 13 has also been shown to be increased in advanced CanL, with values significantly higher than those of dogs with idiopathic chronic kidney disease at the same IRIS stage 11 . It is however not consistently elevated at early stages of the disease, and it is strongly correlated with the severity of systemic arterial hypertension and anaemia 11 …”

“…[4][5][6][7][8][9] The cardiac involvement in CanL has led to research into the potential clinical or research use of cardiac biomarkers in this disease. 4,5,10,11 The main markers currently used for the classification of CanL comprise a subjective evaluation of clinical signs, serology and protein electrophoresis findings, and routine kidney markers such as urine protein/creatinine ratio (UPC) and serum creatinine levels. 3,12 In general, a clinically useful biomarker or a combination of biomarkers should be a tool for staging the disease, acting as a prognostic factor or helping to guide initial or subsequent therapy.…”