title: Relationship between renal function and plasma brain natriuretic peptide in patients with heart failure.
abstract: OBJECTIVE
  This study sought to evaluate the relationship between brain natriuretic peptide (BNP), renal function, and the severity of congestive heart failure (CHF).
  
  
  BACKGROUND
  Both BNP and renal function are prognostic predictors in CHF patients.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan. tutamoto@belle.shiga-med.ac.jp
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsutamoto
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Wada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakai
authors.forename: Chitose
authors.initials: C
authors.lastname: Ishikawa
authors.forename: Toshinari
authors.initials: T
authors.lastname: Tanaka
authors.forename: Masaru
authors.initials: M
authors.lastname: Hayashi
authors.forename: Masanori
authors.initials: M
authors.lastname: Fujii
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Dohke
authors.forename: Masato
authors.initials: M
authors.lastname: Ohnishi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takashima
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D013318:Stroke Volume; D017725:Ventricular Pressure
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain