The ability of NT-proBNP to detect chronic heart failure and predict all-cause mortality is higher in elderly Chinese coronary artery disease patients with chronic kidney disease

Abstract

ObjectiveTo analyze the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and renal function, and compare the ability and cut-off thresholds of NT-proBNP to detect chronic heart failure (CHF) and predict mortality in elderly Chinese coronary artery disease (CAD) patients with and without chronic kidney disease (CKD).MethodsThe study included 999 CAD patients older than 60 years. The endpoint was all-cause mortality over a mean follow-up period of 417 days.ResultsThe median age was 86 years (range: 60–104 years), and the median NT-proBNP level was 409.8 pg/mL. CKD was present in 358 patients. Three hundred and six patients were positive for CHF. One hundred and ten CKD patients and 105 non-CKD patients died. Not only CKD, but also estimated glomerular filtration rate independently affected NT-proBNP. NT-proBNP detected CHF with a cut-off value of 298.4 pg/mL in non-CKD patients and a cut-off value of 435.7 pg/mL in CKD patients. NT-proBNP predicted death with a cut-off value of 369.5 pg/mL in non-CKD patients and a cut-off value of 2584.1 pg/mL in CKD patients. The NT-proBNP level was significantly related to the prevalence of CHF and all-cause mortality in CAD patients with and without CKD; this effect persisted after adjustment. The crude and multiple adjusted hazard ratios of NT-proBNP to detect CHF and predict mortality were significantly higher in patients with CKD compared with the remainder of the population. The addition of NT-proBNP to the three-variable and six-variable models generated a significant increase in the C-statistic.ConclusionAmongst elderly Chinese CAD patients, there was an independently inverse association between NT-proBNP and renal function. With the higher cutoff points, NT-proBNP better detected CHF and better predicted mortality in CKD patients than in non-CKD patients.

Amino-Terminal Pro-B-Type Natriuretic Peptide for Diagnosis and Prognosis in Patients With Renal Dysfunction

“…The pooled risk ratios between patients with preserved and diminished renal function were not significantly different (p-value=0.652), and there was significant heterogeneity in both sub-groups (Figure 2A and 2B). Four of the studies used higher NT-proBNP cut-points for patients with renal dysfunction 28,33-35 , while the remaining studies used the same NT-proBNP cut-points in the different sub-groups of renal function.…”

Prognostic value of plasma NT-proBNP levels in very old patients with moderate renal insufficiency in China

“…Fu et al [24] reported that NTproBNP predicted death with a cut-off value of 369.5 pg/ml in non-CKD patients and a cut-off value of 2584.1 pg/ml in CKD patients. In the present study, the risks of all-cause death and MACEs were particularly increased in patients with NT-proBNP levels ≥ 411.3 pg/ml, suggesting this value as an appropriate cut-off NT-proBNP level for prediction of all-cause death and MACEs in very old patients with stage 3 CKD.…”

Utility of Traditional Circulating and Imaging-Based Cardiac Biomarkers in Patients with Predialysis CKD

“…The association was significantly stronger in those with than without proteinuria (interaction P=0.05) (35). In Chinese patients with known CAD, NT-pro-BNP was associated with all-cause death if eGFR was ,60 ml/min per 1.73 m 2 (36). In addition, the NT-pro-BNP cutoff associated with mortality was higher in patients with CKD (2584 pg/ml) than in persons without CKD (370 pg/ml) (36).…”

“…In Chinese patients with known CAD, NT-pro-BNP was associated with all-cause death if eGFR was ,60 ml/min per 1.73 m 2 (36). In addition, the NT-pro-BNP cutoff associated with mortality was higher in patients with CKD (2584 pg/ml) than in persons without CKD (370 pg/ml) (36). Several other studies reported similar associations between NT-pro-BNP, CV events, and all-cause death (Table 2) (37-39).…”