Relationship Between the Brain Natriuretic Peptide (BNP) Level and Remission of Diabetic Nephropathy with Microalbuminuria: A 3-Year Follow-Up Study

Abstract

The aim of the study was to examine the relationship between the brain natriuretic peptide (BNP) level and progression or remission of diabetic nephropathy with microalbuminuria for 3 years. The subjects were 100 Japanese type 2 diabetes mellitus outpatients with microalbuminuria. Associations between metabolic parameters at baseline [HbA1c, systolic blood pressure (SBP), urine albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and BNP] and the progression or remission of diabetic nephropathy were examined for 3 years. A total of 83 patients were examined at the end of the 3-year period, including 17 with remission to normoalbuminuria, 47 with continuing microalbuminuria, and 19 with progression to macroalbuminuria. HbA1c, ACR, and BNP differed significantly among the 3 groups (p=0.024, p<0.001, p=0.002, respectively). Among baseline factors, HbA1c and BNP were significant predictors of the percentage increase in ACR for 3 years in multiple linear regression analysis (β=0.259, p=0.02; β=0.299, p=0.007, respectively). In multivariate logistic regression analysis, HbA1c and ACR were independently associated with progression of diabetic nephropathy (p=0.008, p=0.023, respectively), and ACR and BNP were independently associated with remission of diabetic nephropathy (p=0.029, p=0.012, respectively). ROC curve analysis gave a cutoff value for BNP of 14.9 pg/ml for prediction of remission of diabetic nephropathy (p=0.016). The BNP level has a relationship with diabetic nephropathy and a low BNP level predicts remission of diabetic nephropathy. Therefore, monitoring of BNP can play an important role in management of diabetic nephropathy.

Nomogram for the prediction of diabetic nephropathy risk among patients with type 2 diabetes mellitus based on a questionnaire and biochemical indicators: a retrospective study

“…Persistent hyperglycemia can induce glomerular mesangial hyperplasia, resulting in basement membrane thickening and glomerular capillary wall sclerosis, ultimately leading to the occurrence of proteinuria. On the other hand, persistent hyperglycemia causes the glomerulus to be in a state of hyperperfusion and hyperfiltration, resulting in capillary sclerosis and changes in vascular permeability, which ultimately leads to plasma protein deposition on capillary walls, progressive vascular hyperplasia, hyaline degeneration and intravascular thrombosis [ 66 ]. Second, blood glucose fluctuates greatly.…”

Relationship Between the Brain Natriuretic Peptide (BNP) Level and Prognosis of Diabetic Nephropathy with Microalbuminuria: A 7-Year Follow-Up Study

“…However, the role of BNP as a predictive factor in diabetic nephropathy has not been established. We previously reported that in diabetes with microalbuminuria the baseline BNP level is independently associated with the annual decline in estimated glomerular filtration rate (eGFR) [19] and prognosis of diabetic nephropathy for 3 years [20]. In the current study, we examined the relationship between the BNP level and prognosis of diabetic nephropathy (progression of diabetic nephropathy, cardiovascular events, and death) over a follow-up period of 7 years.…”

Renoprotective Effects of DPP-4 Inhibitors

“…Experimental studies have shown that BNP is cleaved by DPP-4 to BNP and BNP , the latter of which has less natriuretic, diuretic, and vasodilatory activity than BNP . Several studies have suggested that elevated serum BNP levels may be a predictor for the progression or prognosis of DKD [70][71][72]. Thus far, however, no report has shown that increased BNP levels by DPP-4 inhibitors are associated with the pathogenesis of DKD.…”