NT-proBNP and Echocardiographic Parameters for Prediction of Cardiovascular Outcomes in Patients with CKD Stages G2–G4

Untersteller, Kathrin; Girerd, Nicolas; Duarte, Kévin; Rogačev, Kyrill S.; Seiler-Mußler, Sarah; Fliser, Danilo; Rossignol, Patrick; Heine, Gunnar H.

doi:10.2215/cjn.01660216

Cited by 32 publications

(21 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Notably, even cFGF23 did not remain a strong outcome predictor after adjusting for NT-proBNP. Instead, we confirm NT-proBNP to predict adverse cardiovascular outcome before and after adjustment for plasma FGF23, which is in line with our earlier findings [37] on a very potent prognostic role of NT-proBNP, which remains significant after the adjustment for residual renal function despite the strong correlation between NT-proBNP and eGFR.…”

Section: Discussion/conclusionsupporting

confidence: 91%

Strength of Fibroblast Growth Factor 23 as a Cardiovascular Risk Predictor in Chronic Kidney Disease Weaken by ProBNP Adjustment

Emrich¹,

Brandenburg²,

Sellier³

et al. 2019

Am J Nephrol

Self Cite

View full text Add to dashboard Cite

Background: Various epidemiological studies linked high fibroblast growth factor 23 (FGF23) levels with cardiovascular events in chronic kidney disease (CKD). It remains enigmatic whether high FGF23 exerts adverse cardiovascular effects, or whether it reflects detrimental effects of residual confounders. Earlier studies adjusted for CKD-mineral bone disease (CKD-MBD) regulators of FGF23 rather than for recently discovered non-CKD-MBD regulators, among which iron deficiency and heart failure are of particular importance. Moreover, they used c-terminal FGF23 (cFGF23) assays rather than more specific intact FGF23 (iFGF23) assays. Methods: The CARE FOR HOMe study analyzed plasma ferritin, iFGF23, cFGF23 and N-terminal proBNP (NT-proBNP) along with conventional risk factors, among 575 CKD G2-G4 patients to determine the interaction between FGF23, its non-CKD-MBD regulators, and incident cardiovascular events in CKD patients. The participants were followed up for 5.1 ± 2.1 years for the occurrence of atherosclerotic events and hospitalization for acute decompensated heart failure. Results: cFGF23 correlated strongly with high iFGF23 (r = 0.607), fairly with high NT-proBNP (r = 0.453) and weakly with low ferritin (r = –0.207); correlation coefficients of iFGF23 with NT-proBNP and ferritin were numerically lower. In Kaplan-Meier analyses, both endpoints were predicted by cFGF23 and iFGF23. In Cox regression models, cFGF23 remained an outcome predictor after adjustment for conventional risk factors and ferritin. This prediction was largely eliminated when further adjusting for NT-proBNP. iFGF23 was less consistently associated with adverse outcome in partly adjusted models, and failed to predict outcome in fully adjusted models. Conclusion: In summary, iron deficiency and heart failure affect plasma FGF23. As adjustment for NT-proBNP virtually eliminates the association between plasma FGF23 and predefined outcome, we speculate that high FGF23, rather than exerting detrimental cardiovascular effects, mirrors prevalent heart disease.

show abstract

Section: Discussion/conclusionsupporting

confidence: 91%

Strength of Fibroblast Growth Factor 23 as a Cardiovascular Risk Predictor in Chronic Kidney Disease Weaken by ProBNP Adjustment

Emrich¹,

Brandenburg²,

Sellier³

et al. 2019

Am J Nephrol

Self Cite

View full text Add to dashboard Cite

show abstract

“…We cannot rule out that the reported association of LV hypertrophy with worse clinical outcome of renal patients could be at least in part related to the presence of subclinical LV systolic dysfunction in these patients. Interestingly, increased e/e’ is a reliable and early marker of diastolic dysfunction, which is frequently observed in patients with renal disease [33], in whom it proved to be associated with poor CV outcome [34]. It is conceivable that early subclinical systolic and diastolic dysfunction coexist in renal disease, and probably this mutual relationship accounts for the high mortality and morbidity rate observed in renal patients, independent of disease stage, and even persisting after successful kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

et al. 2018

View full text Add to dashboard Cite

Background: Although heart failure is the most prevalent cardiovascular disease associated with adverse outcome in chronic kidney disease (CKD) and after kidney transplantation, left ventricular (LV) systolic function is often preserved in renal patients. The aim of this study was to evaluate global longitudinal strain (GLS), which is reportedly a more accurate tool for detecting subclinical LV systolic dysfunction, in patients with various degrees of renal function impairment, including kidney transplant recipients (KTRs). Methods: This prospective study evaluated demographic, clinical, and ultrasound data, including the assessment of LV GLS and mitral E peak velocity and averaged ratio of mitral to myocardial early velocities (E/e’), of 70 consecutive renal patients (20 with stage 2–4 CKD, 25 with end-stage renal disease on hemodialysis [HD], and 25 KTRs). All patients had an LV ejection fraction ≥50% and no history of heart failure or coronary artery disease. We used multivariable logistic analysis to assess the risk of compromised GLS. One hundred and twenty control subjects with or without hypertension served as controls. Results: A compromised GLS <–18% was shown in 55% of patients with stage 2–4 CKD, 60% of HD patients, and 28% of KTRs, while it was 32% in hypertensive controls and 12% in non-hypertensive controls (p < 0.0001). Patients with HD had higher systolic pressure and a significantly greater prevalence of increased LV mass and diastolic dysfunction. In renal patients, E/e’ (p = 0.025), and LV mass index (p = 0.063) were independent predictors of compromised GLS at logistic regression analysis. E/e’, systolic artery pressure, and LV mass also exhibited the greatest areas under the curve on receiver operating characteristic analysis to identify a compromised GLS. Conclusions: Renal disease proved to be associated with early and subclinical impairment of LV systolic function, which persists after starting dialysis and even in spite of successful kidney transplantation. An increased E/e’ resulted to be the most powerful independent predictor of abnormal GLS.

show abstract

“…As indicated in the Introduction, mortality rates in the course of CKD are highest when patients receive dialysis [1, 20]. The published literature and our results indicate that such high mortality rates are also associated with significantly high levels of NT-proBNP [17]. …”

Section: Discussionmentioning

confidence: 67%

“…The most frequently assayed natriuretic peptide in clinical practice is N-terminal prohormone of brain natriuretic peptide (NT-proBNP), secreted in cardiomyocytes under the conditions of pressure and volume overload in cardiac chambers [16]. It has been proved that in CKD patients, elevated NT-proBNP levels are, on the one hand, associated with the advancement of kidney disease and may, on the other hand, also serve as a prognostic parameter [17], although the latter option is much less well documented. In our study, we assessed the influence of laboratory parameters, with particular attention given to NT-proBNP, and of echocardiographic parameters on the survival of non-dialysis patients with stage 3–5 CKD in long-term observation.…”

Section: Introductionmentioning

confidence: 99%

NT-proBNP in the Prognosis of Death or Need for Renal Replacement Therapy in Patients with Stage 3–5 Chronic Kidney Disease

Gromadziński

Januszko‐Giergielewicz

Czarnacka³

et al. 2019

Cardiorenal Med

View full text Add to dashboard Cite

Background: The risk of cardiovascular (CV) complications is much greater in patients with chronic kidney disease (CKD). The aim of this study was to assess predictors of mortality, renal failure progression, and the need for dialysis in patients with CKD. Methods: The study group consisted of 70 patients with stage 3–5 CKD, followed up on average for 33.4 ± 15.6 months. Laboratory tests and echocardiography were performed on all patients. Composite endpoints were defined as (1) all-cause mortality and (2) mortality or renal replacement therapy (RRT), defined as the initiation of dialysis therapy. Results: During the observation period, 13 patients died and 11 began dialysis therapy. NT-proBNP was found to be a significant predictor in receiver operating characteristic curve analysis for all study endpoints. The optimal cutoff value for NT-proBNP as a predictor of mortality was 569.8 pg/mL, with a sensitivity of 53.8% and a specificity of 89.1%. For mortality or RRT, the cutoff value for NT-proBNP was 384.9 pg/mL, with a sensitivity and specificity of 70.8 and 72.7%, respectively. In a multivariate regression analysis, NT-proBNP was an independent predictor of mortality with an OR = 7.5 (95% CI: 1.05–53.87; p = 0.044) and of mortality or RRT with an OR = 4.7 (95% CI: 1.01–22.66; p = 0.048). Conclusions: NT-proBNP is an independent predictor of mortality in patients with CKD and can also be useful for CV risk stratification in this patient population.

show abstract

NT-proBNP and Echocardiographic Parameters for Prediction of Cardiovascular Outcomes in Patients with CKD Stages G2–G4

Abstract: Our data confirm NT-proBNP is an independent predictor of adverse outcomes in patients with CKD. The additional use of echocardiography for improvement of risk stratification is not supported by our results.

Cited by 32 publications

References 40 publications

Strength of Fibroblast Growth Factor 23 as a Cardiovascular Risk Predictor in Chronic Kidney Disease Weaken by ProBNP Adjustment

Strength of Fibroblast Growth Factor 23 as a Cardiovascular Risk Predictor in Chronic Kidney Disease Weaken by ProBNP Adjustment

Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

NT-proBNP in the Prognosis of Death or Need for Renal Replacement Therapy in Patients with Stage 3–5 Chronic Kidney Disease

Contact Info

Product

Resources

About