title: Prognostic potential of brain natriuretic peptide (BNP) in predialysis chronic kidney disease patients.
abstract: In the present study, we investigated the potential of N-BNP (N-terminal B-type natriuretic peptide) as a prognostic marker for risk of CV (cardiovascular) events, overall mortality and progression to ESRD (end-stage renal disease) in a cohort of 83 pre-dialysis CKD (chronic kidney disease) patients without clinical evidence of heart failure. During the study, ten patients reached the combined end point of overall mortality and/or CV event. Univariate factors associated with the combined end point were plasma N-BNP (P < 0.0005), creatinine (P < 0.002), systolic blood pressure (P < 0.009) and age (P < 0.015). N-BNP levels were higher in patients with CV events (P < 0.0005). Cox model regression analysis yielded log10 N-BNP (hazard ratio, 9.608; P < 0.007) and pre-existing CV disease (hazard ratio, 4.571; P < 0.029) as independent predictors of overall mortality or CV events. Kaplan-Meier analysis curves for the subgroup with supramedian creatinine levels (225 micromol/l) showed significant separation of the curves stratified for plasma N-BNP levels above and below the group median (291 pmol/l) for all end points. Receiver-operator-characteristic curves for N-BNP (355 pmol/l cut-off) demonstrated a specificity of 65.8% at a sensitivity of 100% for predicting CV events/overall mortality. The measurement of plasma N-BNP may aid in the risk stratification of pre-dialysis CKD patients. The high sensitivity and negative predictive value (100%) may enable the selection of patients who could safely be excluded from further investigations, resulting in better focusing of resources.
authors.affiliation: Department of Nephrology, University Hospital of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. Sue.Carr@uhl-tr.nhs.uk
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Carr
authors.forename: Sunita
authors.initials: S
authors.lastname: Bavanandan
authors.forename: Barbara
authors.initials: B
authors.lastname: Fentum
authors.forename: Leong
authors.initials: L
authors.lastname: Ng
mesh_terms: D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain