B-type natriuretic peptides are reliable markers of cardiac strain in CKD pediatric patients.
Myocardial damage and strain are common in children with chronic renal failure. The most prevalent pathologies, as defined by echocardiography, are left ventricular hypertrophy (LVH), diastolic and systolic dysfunction, and altered LV geometry. Troponin I and T, as well as B-type natriuretic peptide (BNP) and its cleavage fragment NT-proBNP, are known to be good markers of myocardial damage and stress, respectively, in the general adult population and among those with chronic kidney disease (CKD). In this study we measured the levels of troponins I and T, BNP, and NT-proBNP in a group of children and young adults with CKD stages 3-5 and determined their respective correlations with echocardiographic and laboratory abnormalities. BNP and NT-proBNP levels and their log values correlated well with the following parameters: diastolic blood pressure, estimated glomerular filtration rate, time-averaged hemoglobin levels, and LV mass. Both BNP and NT-proBNP levels, but not those of either troponin, were found to be reliable surrogate markers of strained hearts, defined as having LVH or diastolic or systolic dysfunction, in the pediatric CKD stages 3-4 group. The log NT-proBNP value was also found to be a good marker of cardiac strain in the CKD stage 5 group of patients. Serum BNP and NT-proBNP threshold concentrations of 43 and 529 pg/ml, respectively, were found to have the best sensitivity and specificity in predicting strained hearts. Based on these findings, we conclude that both BNP and NT-proBNP levels, but not those of troponins I and T, can serve as inexpensive, simple, and reliable markers of stressed hearts in the pediatric CKD patient population.
Pediatric Nephrology, Shaare Zedek Medical Center, The Hadassah-Hebrew University School of Medicine, Jerusalem, Israel. chrinat@szmc.org.il
Choni
C
Rinat
Rachel
R
Becker-Cohen
Amiram
A
Nir
Sofia
S
Feinstein
Nurit
N
Algur
Efrat
E
Ben-Shalom
Benjamin
B
Farber
Yaacov
Y
Frishberg
D000293:Adolescent; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D006321:Heart / Q000503:physiopathology; D006331:Heart Diseases / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood; D055815:Young Adult
D015415:Biomarkers; D014336:Troponin; D020097:Natriuretic Peptide, Brain