Association of cardiac and renal function with extreme N-terminal fragment Pro-B-type natriuretic peptide levels in elderly patients

BMC Cardiovascular Disorders

Yixin Hu¹  Fan Wang¹  Yongyi Bai¹  Jian Cao¹  Ping Ye¹  Li Fan¹  Lin Liu¹  Guoliang Huo¹  Hua Cui¹ 

[1]Second Geriatric Cardiology Division, Chinese PLA General Hospital, No 28 Fuxing Road, Beijing, 100853, P. R. China

关键词: Impaired renal function;    Elderly;    Factors;    NT pro-BNP;   

Others  :  1084695
DOI  :  10.1186/1471-2261-12-57

 received in 2012-01-19, accepted in 2012-07-26,  发布年份 2012

【 摘 要 】

Background

The data are inconsistent regarding whether extreme N-terminal fragment pro-B-type natriuretic peptide (NT pro-BNP) levels are associated with impaired renal function. Furthermore, the relationship between extreme NT pro-BNP levels and cardiac and renal function in elderly patients has not been reported. The aim of the present study was to examine a hypothesis that extreme NT pro-BNP levels may be associated with impaired cardiac and renal function in elderly patients.

Methods

We retrospectively analyzed the data of demographic, clinical, and echocardiographic features on 152 consecutive elderly patients aged more than 80 years old (average age, 83.65 ± 3.58 years) with NT pro-BNP levels ≥ 3000 pg/ml. The participants were divided into two categories according to their NT pro-BNP levels: (1) 3000–10000 pg/mL and (2) >10000 pg /mL.

Results

The number of patients with impaired renal function (P = 0.019) and the mortality (P < 0.001) in the period of inpatient was higher in the group with NT pro-BNP > 10000 pg /mL. The levels of serum creatinine and creatine kinase MB (CK-MB) in the group of NT pro-BNP > 10000 pg / mL were higher than those in the group of NT pro-BNP = 3000-10000 pg/mL (P = 0.001 and P = 0.023, respectively). Furthermore, no significant difference in the distribution by NYHA class in different NT pro-BNP levels was observed. Multiple linear regression analyses demonstrated that with NT pro-BNP levels as the dependent variable, NT pro-BNP levels were positively correlated with CK-MB (β = 0.182, P = 0.024) and creatinine levels (β = 0.281, P = 0.001). The area under the receiver-operating characteristic (ROC) curve of NT pro-BNP levels and clinical diagnosis of impaired renal function was 0.596 and reached significant difference (95%CI:0.503-0.688, P = 0.044).

Conclusion

These data suggest that the extreme elevation of NT pro-BNP levels (≥3000 pg/ml) is mainly determined by impaired renal function in elderly patients above 80 years. Extreme NT pro-BNP levels may be useful for assessing the severity of impaired renal function.

【 授权许可】

   
2012 Cui et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Levin ER, Gardner DG, Samson WK: Natriuretic peptides. N Engl J Med 1998, 339:321-328.
• [2]Daniels LB, Maisel AS: Natriuretic peptides. J Am Coll Cardiol 2007, 50:2357-2368.
• [3]Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008, 29:2388-2442.
• [4]DeFilippi C, van Kimmenade RR, Pinto YM: Amino-terminal pro-B-type natriuretic peptide testing in renal disease. Am J Cardiol 2008, 101:82-88.
• [5]Law C, Glover C, Benson K, Guglin M: Extremely high brain natriuretic peptide does not reflect the severity of heart failure. Congest Heart Fail 2010, 16:221-225.
• [6]Guglin M, Hourani R, Pitta S: Factors determining extreme brain natriuretic peptide elevation. Congest Heart Fail 2007, 13:136-141.
• [7]Robinson BE: Epidemiology of chronic kidney disease and anemia. J Am Med Dir Assoc 2006, 7(9 Suppl):S3-S6. quiz S17-21
• [8]Maisel AS, Clopton P, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Steg G, Westheim A, Knudsen CW, Perez A, Kazanegra R, Bhalla V, Herrmann HC, Aumont MC, McCullough PA: Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: results from the Breathing Not Properly (BNP) multinational study. Am Heart J 2004, 147:1078-1084.
• [9]Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS: Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003, 41:1-12.
• [10]Nitta K, Kawashima A, Yumura W, Naruse M, Oba T, Kabaya T, Nihei H: Plasma concentration of brain natriuretic peptide as an indicator of cardiac ventricular function in patients on hemodialysis. Am J Nephrol 1998, 18:411-415.
• [11]Yang JW, Kim MS, Kim JS, Yoo JM, Han ST, Kim BR, Kim YD, Choi JW, Choi SO, Han BG: Relationship between serum brain natriuretic peptide and heart function in patients with chronic kidney disease. Korean J Intern Med 2008, 23:191-200.
• [12]Prnjavorac B, Abduzaimovic K, Jukic J, Sejdinovic R, Mujaric E, Irejiz N, Hadzovic-Dzuvo A, Jadric R, Causevic A, Semiz S, Bego T, Malenica M: Use of amino-terminal pro-B type natriuretic peptide as the parameter for long-term monitoring of water overload in patient with chronic kidney diseases. Med Glas Ljek komore Zenicko-doboj kantona 2011, 8:116-120.
• [13]Tang WH, Francis GS, Morrow DA, Newby LK, Cannon CP, Jesse RL, Storrow AB, Christenson RH: National academy of clinical biochemistry laboratory medicine practice guidelines: clinical utilization of cardiac biomarker testing in heart failure. Clin Biochem 2008, 41:210-221.
• [14]Pemberton CJ, Johnson ML, Yandle TG, Espiner E: Deconvolution analysis of cardiac natriuretic peptides during acute volume overload. Hypertension 2000, 36:355-359.
• [15]Liang F, O’Rear J, Schellenberger U, Tai L, Lasecki M, Schreiner GF, Apple FS, Maisel AS, Pollitt NS, Protter AA: Evidence for functional heterogeneity of circulating B-type natriuretic peptide. J Am Coll Cardiol 2007, 49:1071-1078.
• [16]Xu-Cai YO, Wu Q: Molecular forms of natriuretic peptides in heart failure and their implications. Heart 2009, 96:419-424.
• [17]Rudiger A, Gasser S, Fischler M, Hornemann T, von Eckardstein A, Maggiorini M: Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure. Crit Care Med 2006, 34:2140-2144.
• [18]Doust JA, Pietrzak E, Dobson A, Glasziou P: How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review. BMJ 2005, 330:625.
• [19]Vaes B, de Ruijter W, Degryse J, Westendorp RG, Gussekloo J: Clinical relevance of a raised plasma N-terminal pro-brain natriuretic peptide level in a population-based cohort of nonagenarians. J Am Geriatr Soc 2009, 57:823-829.
• [20]Bettencourt P, Azevedo A, Pimenta J, Frioes F, Ferreira S, Ferreira A: N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation 2004, 110:2168-2174.
• [21]Ogawa T, Veinot JP, Davies RA, Haddad H, Smith SJ, Masters RG, Hendry PJ, Starling R, de Bold MK, Ponce A, Ma KK, Williams K, de Bold AJ: Neuroendocrine profiling of humans receiving cardiac allografts. J Heart Lung Transplant 2005, 24:1046-1054.
• [22]Crilley JG, Farrer M: Left ventricular remodelling and brain natriuretic peptide after first myocardial infarction. Heart 2001, 86:638-642.
• [23]Hunt PJ, Yandle TG, Nicholls MG, Richards AM, Espiner EA: The amino-terminal portion of pro-brain natriuretic peptide (Pro-BNP) circulates in human plasma. Biochem Biophys Res Commun 1995, 214:1175-1183.
• [24]Hunt PJ, Richards AM, Nicholls MG, Yandle TG, Doughty RN, Espiner EA: Immunoreactive amino-terminal pro-brain natriuretic peptide (NT PRO-BNP): a new marker of cardiac impairment. Clin Endocrinol (Oxf) 1997, 47:287-296.
• [25]Melki D, Lind S, Agewall S, Jernberg T: Prognostic value of combining high sensitive troponin T and N-terminal pro B-type natriuretic peptide in chest pain patients with no persistent ST-elevation. Clin Chim Acta 2012, 413(9–10):933-937.
• [26]Ridker PM, Rifai N, Rose L, Buring JE, Cook NR: Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002, 347:1557-1565.
• [27]Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB: Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet 1997, 349:462-466.
• [28]Kistorp C, Raymond I, Pedersen F, Gustafsson F, Faber J, Hildebrandt P: N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA 2005, 293:1609-1616.
• [29]Raymond I, Groenning BA, Hildebrandt PR, Nilsson JC, Baumann M, Trawinski J, Pedersen F: The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population. Heart 2003, 89:745-751.
• [30]Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC: Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardiol 2002, 40:976-982.
• [31]Troughton RW, Richards AM, Yandle TG, Frampton CM, Nicholls MG: The effects of medications on circulating levels of cardiac natriuretic peptides. Ann Med 2007, 39:242-260.