Relationship Between Renal Function and Plasma Brain Natriuretic Peptide in Patients With Heart Failure

Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
Journal of the American College of Cardiology (Impact Factor: 16.5). 03/2006; 47(3):582-6. DOI: 10.1016/j.jacc.2005.10.038
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This study sought to evaluate the relationship between brain natriuretic peptide (BNP), renal function, and the severity of congestive heart failure (CHF).
Both BNP and renal function are prognostic predictors in CHF patients.
We measured the plasma BNP level in the aortic root and coronary sinus in 366 consecutive patients with CHF. Estimated glomerular filtration rate (eGFR) by the Cockcroft-Gault equation was used as an indicator of renal function.
By stepwise multivariate analyses, hemodynamic parameters such as left ventricular ejection fraction (LVEF) and left ventricular end-diastolic pressure (LVEDP) but not eGFR were independent predictors of a transcardiac increase (coronary sinus-aortic root) in BNP. Regarding the plasma level of BNP in the aortic root, not only LVEF (p < 0.0001) and LVEDP (p < 0.0001) but also eGFR (p < 0.0001) were independent predictors. Patients were divided into two groups, patients with an eGFR > or =60 ml/min (group 1, n = 229) and patients with an eGFR <60 ml/min (group 2, n = 137). There was no difference in LVEF, LVEDP, or the transcardiac gradient of BNP between the two groups, but the plasma level of BNP in the aortic root was approximately two-fold greater in group 2 than in the group 1.
These findings suggest that decreased clearance from the kidney contributes to the elevated BNP in CHF patients with renal dysfunction, especially in patients with an eGFR <60 ml/min.

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Available from: Minoru Horie, Dec 16, 2013
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    • "However, NPs have limitations that affect the interpretation of the results. Elevated NP levels can also be seen in the setting of sepsis [4], acute pulmonary embolism [5] and renal dysfunction [6]. NP levels are higher in women than in men and increase with age [7]. "
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    ABSTRACT: BackgroundThere is increasing interest in utilising novel markers of cardiovascular disease risk in patients with chronic heart failure (HF). Recently, it was shown that alpha-1-antichymotrypsin (ACT), an acute-phase protein and major inhibitor of cathpesin G, plays a role in the pathophysiology of HF and may serve as a marker for myocardial distress.ObjectiveTo assess whether ACT is independently associated with long-term mortality in chronic HF patients.MethodsACT plasma levels were categorised into quartiles. Survival times were analysed using Kaplan-Meier curves and Cox proportional hazards regression, without and with correction for clinically relevant risk factors, including sex, age, duration of HF, kidney function (MDRD), ischaemic HF aetiology and NT-proBNP.ResultsTwenty healthy individuals and 224 patients (mean age 71 years, 72 % male, median HF duration 1.6 years) with chronic HF were included. In total, 159 (71 %) patients died. The median survival time was 5.3 (95 % CI 4.5–6.1) years. ACT was significantly elevated in patients (median 433 μg/ml, IQR 279–680) in comparison with controls (median 214 μg/ml, IQR 166–271; p < 0.001). Cox regression analysis demonstrated that ACT was not independently related to long-term mortality in chronic HF patients (crude HR = 1.03, 95 % CI 0.75–1.41, p = 0.871; adjusted HR = 1.12, 95 % CI 0.78–1.60, p = 0.552), which was confirmed by Kaplan-Meier curves.ConclusionACT levels are elevated in chronic HF patients, but no independent association with long-term mortality can be established.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 08/2014; 22(9). DOI:10.1007/s12471-014-0584-2 · 1.84 Impact Factor
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    • "The higher achieved Hb level, irrespective of the treatment groups, was also associated with the lower hANP or BNP levels. hANP and BNP levels reflect left ventricular overload [25] [26] [27] [28]. Thus, the observed improvement in neurohumoral factors represents Fig. 2. Time course of hemoglobin (Hb) levels, blood pressure, and estimated glomerular filtration rates (eGFR). "
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    ABSTRACT: Background and purpose To assess effects of long-term anemia management on left ventricular hypertrophy in patients with chronic kidney disease (CKD) not on dialysis, we performed secondary outcome analyses of a randomized controlled study that evaluated effects of anemia management with erythropoiesis stimulating agents in this population. Methods and subjects Subjects [hemoglobin (Hb) < 10.0 g/dL, 2.0 ≤ serum creatinine < 6.0 mg/dL] were randomized either to high Hb (11.0 ≤ target Hb ≤ 13.0 g/dL with darbepoetin alfa), or to low Hb group (9.0 ≤ target Hb ≤ 11.0 g/dL with recombinant human erythropoietin), and followed up to 48 weeks. Data from echocardiographic evaluation and values of neurohumoral factors associated with heart failure were assessed in subjects whose data were evaluable both at the baseline and at the end point. Results The high Hb group achieved target range Hb levels (12.1 ± 1.1 g/dL, at 32 weeks, N = 111), which was significantly higher (p < 0.001) than the low Hb group (N = 95). Though blood pressure and renal function changes were similar between the groups, left ventricular diastolic dimension was significantly decreased only in the high Hb group (p < 0.001), and the change in left ventricular mass index (LVMI) correlated coarsely but significantly with the achieved Hb levels (r = 0.147, p = 0.032). The higher Hb levels were associated with greater reduction in LVMI and left ventricular wall thickness, and the lower Hb levels with the greater increase in human arterial- or brain natriuretic polypeptide levels. Conclusions Anemia correction targeting modestly higher Hb levels better preserves cardiac function in CKD patients not on dialysis.
    Journal of Cardiology 10/2013; 62(4):249–256. DOI:10.1016/j.jjcc.2013.04.008 · 2.78 Impact Factor
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    • "Similar data exists on the effect of creatinine clearance on the diagnostic accuracy of CHF for BNP [25-27]. Several studies have shown an independent effect of renal function on BNP in the absence of elevated left ventricular filling pressures [25, 26], while McCullough et al. reported that renal function influences the cut point for BNP in the diagnosis of CHF [27]. "
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    ABSTRACT: The routine use of natiuretic peptides in severely dyspneic patients has recently been called into question. We hypothesized that the diagnostic utility of Amino Terminal pro Brain Natiuretic Peptide (NT-proBNP) is diminished in a complex elderly population. We studied 502 consecutive patients in whom NT-proBNP values were obtained to evaluate severe dyspnea in the emergency department. The diagnostic utility of NT-proBNP for the diagnosis of congestive heart failure (CHF) was assessed utilizing several published guidelines, as well as the manufacturers suggested age dependent cut-off points. The area under the receiver operator curve (AUC) for NT-proBNP was 0.70. Using age-related cut points, the diagnostic accuracy of NT-proBNP for the diagnosis of CHF was below prior reports (70% vs. 83%). Age and estimated creatinine clearance correlated directly with NT-proBNP levels, while hematocrit correlated inversely. Both age > 50 years and to a lesser extent hematocrit < 30% affected the diagnostic accuracy of NT-proBNP, while renal function had no effect. In multivariate analysis, a prior history of CHF was the best predictor of current CHF, odds ratio (OR) = 45; CI: 23-88. The diagnostic accuracy of NT-proBNP for the evaluation of CHF appears less robust in an elderly population with a high prevalence of prior CHF. Age and hematocrit levels, may adversely affect the diagnostic accuracy off NT-proBNP. Congestive Heart Failure; Natriuretic peptides; Diagnosis; Elderly Patients.
    Journal of Clinical Medicine Research 07/2011; 3(4):156-63. DOI:10.4021/jocmr606w
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