title: Amino terminal B-type natriuretic peptide, renal function, and prognosis in acute heart failure: a hospital cohort study.
abstract: BACKGROUND
  Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a valuable diagnostic and prognostic test in heart failure (HF). Limited information is available concerning its use in patients with renal failure, in whom dependence on renal clearance may negatively affect its performance.
  
  
  RESULTS
  We evaluated influence of renal function on NT-proBNP levels and on its prognostic value after hospital discharge in 283 acute HF patients. Admission and discharge NT-proBNP levels were higher in patients with decreased estimated glomerular filtration rate (eGFR). In these patients discharge NT-proBNP above median was associated to occurrence of death or readmission at 6 months (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.27-5.03); in patients with normal eGFR, a trend to this association was found (HR 1.64, CI 0.98-2.76). Decrease in NT-proBNP less than 30% of baseline was associated to outcome in patients with normal eGFR (HR 2.68, CI 1.54-4.68) and decreased eGFR (HR 2.54, CI 1.49-4.33).
  
  
  CONCLUSIONS
  Acute HF patients with renal failure have higher NT-proBNP levels than those with normal renal function. Discharge NT-proBNP has long-term prognostic value in HF patients with renal dysfunction. NT-proBNP variations during hospitalization provide additional prognostic information either in patients with normal or reduced eGFR.
authors.affiliation: Department of Internal Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
authors.forename: Joana Martins
authors.initials: JM
authors.lastname: Pimenta
authors.forename: Rui
authors.initials: R
authors.lastname: Almeida
authors.forename: José Paulo
authors.initials: JP
authors.lastname: Araújo
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Fernando
authors.initials: F
authors.lastname: Friões
authors.forename: Francisco
authors.initials: F
authors.lastname: Rocha-Gonçalves
authors.forename: António
authors.initials: A
authors.lastname: Ferreira
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011174:Portugal / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain