NT-proBNP as a Potential Marker of Cardiovascular Damage in Children with Chronic Kidney Disease

Abstract

Assessing cardiovascular disease (CVD) in children with chronic kidney disease (CKD) is difficult. Great expectations have been associated with biomarkers, including the N-terminal pro-brain natriuretic peptide (NT-proBNP). This study aimed to determine the correlation between NT-proBNP and cardiovascular complications in children with CKD. Serum NT-proBNP, arterial stiffness, common carotid artery intima-media thickness (cIMT), echocardiographic (ECHO) parameters (including tissue Doppler imaging), and biochemical and clinical data were analyzed in 38 pediatric patients with CKD (21 boys, 12.2 ± 4.2 years). Mean NT-proBNP in CKD patients was 1068.1 ± 4630 pg/mL. NT-proBNP above the norm (125 pg/mL) was found in 16 (42.1%) subjects. NT-proBNP correlated with glomerular filtration rate (GFR) (r = −0.423, p = 0.008), and was significantly higher in CKD G5 (glomerular filtration rate grade) patients compared to CKD G2, G3, and G4 children (p = 0.010, p = 0.004, and p = 0.018, respectively). Moreover, NT-proBNP correlated positively with augmentation index (AP/PP: r = 0.451, p = 0.018, P2/P: r = 0.460, p = 0.016), cIMT (r = 0.504, p = 0.020), and E/E’ in ECHO (r = 0.400, p = 0.032). In multivariate analysis, logNT-proBNP was the only significant predictor of cIMT Z-score (beta = 0.402, 95CI (0.082–0.721), p = 0.014) and P2/P1 (beta = 0.130, 95CI (0.082–0.721), p = 0.014). Conclusions: NT-proBNP may serve as a possible marker of thickening of the carotid artery wall in pediatric patients with CKD. The final role of NT-proBNP as a biomarker of arterial damage, left ventricular hypertrophy, or cardiac diastolic dysfunction in CKD children needs confirmation in prospective studies.

Plasma Brain Natriuretic Peptide Levels in Children with Chronic Kidney Disease and Renal Transplant Recipients: A Single Center Study

“…In contrast, in a recent study on HD children, EF was not affected by HD and its values were not correlated to pre- and post-HD BNP levels [ 25 ]. Finally, although there are data supporting a positive correlation between BNP (or NT-proBNP) levels and systolic and/or diastolic blood pressure in CKD children, other studies showed, in accordance with our results, that NT-proBNP levels did not correlate with SBP or DBP [ 12 , 13 , 23 , 37 , 38 ].…”

“…A significant inverse correlation was found, between BNP levels and eGFR and a positive one between BNP levels and CKD stage, serum creatinine and cystatin C levels. An increase in BNP or NT-proBNP levels with decreasing eGFR and increasing CKD stage has been reported in other studies [ 10 , 12 , 36 , 37 ]. In a study by Rinat et al, eGFR was an independent factor influencing BNP and NT-proBNP values [ 12 ].…”

“…An inverse correlation between BNP or NT-proBNP and albumin levels has been reported in patients with cardiac heart failure and poor long prognosis [ 42 ]. Finally, higher BNP levels in CKD patients with high iPTH than those with low iPTH, as well as no relation between the above parameters, have been reported [ 22 , 36 , 37 , 41 ].…”

Circadian Blood Pressure Profile in Pediatric Patients with Primary Hypertension

“…Left ventricle mass index (LVMI) was calculated with parameters drawn from echocardiography (ECHO) measurements using M-mode assessment of the left ventricle with simultaneous recording of ECG in the second limb lead. The detailed methodology was described in our recently published manuscript [21]. Measurements were carried out with Philips iE33 device, using an S5-1 transducer (Philips, Amsterdam, the Netherlands).…”