title: Pro-A-type natriuretic peptide and pro-adrenomedullin predict progression of chronic kidney disease: the MMKD Study.
abstract: A-type natriuretic peptide (ANP) and adrenomedullin (ADM) are potent hypotensive, diuretic, and natriuretic peptides involved in maintaining cardiovascular and renal homeostasis. We conducted a prospective 7-year study of 177 nondiabetic patients with primary chronic kidney disease to see if ANP and ADM plasma concentrations predict the progression of their disease, using novel sandwich immunoassays covering the midregional epitopes of the stable prohormones (MRproANP and MR-proADM). Progression of chronic kidney disease was defined as doubling of baseline serum creatinine and/or terminal renal failure, which occurred in 65 patients. Analysis of the receiver operating characteristic curve for the prediction of renal endpoints showed similar areas under the curve for the glomerular filtration rate (GFR) (0.838), MR-proANP (0.810), and MRproADM (0.876), respectively, as did the Kaplan-Meier curve analyses of the patients stratified according to the median of the respective markers. In separate multiple Cox-proportional hazard regression analyses, increased plasma concentrations of both peptides were each strongly predictive of the progression of chronic kidney disease after adjustments for age, gender, GFR, proteinuria and amino-terminal pro-B-type natriuretic peptide. Our study suggests that MR-proANP and MR-proADM are useful new markers of progression of primary nondiabetic chronic kidney disease.
authors.affiliation: Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Dieplinger
authors.forename: Thomas
authors.initials: T
authors.lastname: Mueller
authors.forename: Barbara
authors.initials: B
authors.lastname: Kollerits
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Arnold
authors.initials: A
authors.lastname: von Eckardstein
authors.forename: Meinhard
authors.initials: M
authors.lastname: Haltmayer
authors.forename: Florian
authors.initials: F
authors.lastname: Kronenberg
mesh_terms: D000293:Adolescent; D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007118:Immunoassay; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin