Improvement of the cardiac marker N-terminal-pro brain natriuretic peptide through adjustment for renal function: a stratified multicenter trial

Abstract

Background: N-terminal-pro brain natriuretic peptide (NTproBNP) is a useful cardiac marker that is also influenced by renal dysfunction. It was our objective to assess the relationship between NT-proBNP concentrations in plasma and worsening renal function, and to attempt adjustment of NTproBNP for renal dysfunction in a prospective, stratified multi-center study. Methods: We stratified 203 male patients according to their cardiac status and the estimated glomerular filtration rate (eGFR). Cardiac disease was assessed by medical history, physical examination and standardized echocardiography. Patients were stratified according to the following: absence of cardiac history and abnormalities (control, CTRL, ns66), cardiac history without left ventricular hypertrophy (LVH) or left ventricular systolic dysfunction (LVD) (history, ns30), LVH without systolic dysfunction (LVH, ns68), and LVD wejection fraction (EF) -40%, LVD, ns39x. Renal disease

Association of Plasminuria with Overhydration in Patients with CKD

“…Laboratory parameters were determined using automated Siemens autoanalyzers (Advia 1800 and Immulite 2000). N-terminal pro brain natriuretic peptide (NT-pro-BNP) was corrected for Modification of Diet in Renal Disease GFR according to the formula by Luchner et al (23). Serum aldosterone and plasma renin activity were measured manually using RIA methods (Immunotech, Prague, Czech Republic and Zentech, Angleur, Belgium).…”

N‐terminal proB‐type natriuretic peptide levels aid the diagnosis of left ventricular dysfunction in patients with severe acute exacerbations of chronic obstructive pulmonary disease and renal dysfunction

“…A study from our group has previously validated the usefulness of N‐terminal proB‐type natriuretic peptide (NT‐proBNP) measurements in the diagnosis of LVD associated with AECOPD, 10 where natriuretic peptides may be liberated by alternative mechanisms such as those associated with pulmonary hypertension, hypoxaemia and right ventricular stress, 11 and accounting for the higher threshold values compared with those in patients with isolated LVD 10,12 . Patients with severe renal impairment were, however, excluded, since natriuretic peptides are removed from the circulation by the kidneys and may be markedly elevated in terminal renal failure without associated LVD 13–18 . However, recent studies have suggested that natriuretic peptides may still show good discriminative power for the diagnosis of cardiac dysfunction even in patients with renal impairment 19–22 …”

“…10,12 Patients with severe renal impairment were, however, excluded, since natriuretic peptides are removed from the circulation by the kidneys and may be markedly elevated in terminal renal failure without associated LVD. [13][14][15][16][17][18] However, recent studies have suggested that natriuretic peptides may still show good discriminative power for the diagnosis of cardiac dysfunction even in patients with renal impairment. [19][20][21][22] The present study was conducted in order to evaluate the performance of NT-proBNP measurements in the diagnosis of LVD associated with AECOPD in patients with or without renal dysfunction.…”

Higher Serum Concentrations of N-Terminal Pro-B-Type Natriuretic Peptide Associate with Prevalent Hypertension whereas Lower Associate with Incident Hypertension

“…Furthermore, we also examined the associations between baseline NT-proBNP and changes in BP in the overweight segment of “the incident study population”, and although not statistically significant ( P = 0.13), one SD lower NT-proBNP concentration at baseline was associated with a 0.5 mm Hg higher SBP at follow-up taking use of antihypertensive medication into account [ 25 ]. Finally, excluding participants with serum concentrations of NT-proBNP exceeding 200 pg/mL (n = 156), indicative of subclinical structural heart disease [ 26 ], or applying the NT-proBNP adjustment algorithm, as suggested by Luchner et al [ 27 ], did not change the results in the main analyses (data not shown).…”