title: Best use of cardiac biomarkers in patients with AL amyloidosis and renal failure.
abstract: In AL amyloidosis prognosis depends on the severity of heart dysfunction which is best assessed by natriuretic peptides (BNP and NT-proBNP). However, their clearance relies on glomerular filtration rate (GFR) and their concentration increases with renal failure. We evaluated the diagnostic and prognostic performance of NT-proBNP and BNP in 248 patients with AL amyloidosis with different degrees of renal failure. Patients were grouped according to GFR. Group 1 comprised 109 patients with GFR ≥60 mL/min/1.73 m(2) , Group 2, 77 subjects with GFR <60 and ≥15 mL/min/1.73 m(2) , and Group 3, 62 patients with GFR <15 mL/min/1.73 m(2) . The ability of natriuretic peptides to detect heart involvement and to predict survival in the three groups was assessed. Decreasing eGFR required higher cutoffs of both NT-proBNP and BNP for detecting heart involvement and predicting survival. Both natriuretic peptides were independent prognostic markers in Groups 1 and 2, whereas in Group 3 only BNP independently predicted survival. Natriuretic peptides are powerful and useful markers of cardiac dysfunction and prognosis, provided that eGFR is considered in interpreting their clinical meaning. BNP should be preferred in patients with end-stage renal failure.
authors.affiliation: Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories-Department of Molecular Medicine, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Pavia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palladini
authors.forename: Andrea
authors.initials: A
authors.lastname: Foli
authors.forename: Paolo
authors.initials: P
authors.lastname: Milani
authors.forename: Paola
authors.initials: P
authors.lastname: Russo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Albertini
authors.forename: Francesca
authors.initials: F
authors.lastname: Lavatelli
authors.forename: Laura
authors.initials: L
authors.lastname: Obici
authors.forename: Stefano
authors.initials: S
authors.lastname: Perlini
authors.forename: Remigio
authors.initials: R
authors.lastname: Moratti
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Merlini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000682:Amyloid / Q000032:analysis*; D000686:Amyloidosis / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D015415:Biomarkers; D009202:Cardiomyopathies / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005919:Glomerular Filtration Rate; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000628:therapy; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D017933:Peripheral Nervous System / Q000473:pathology; D010530:Peritoneal Dialysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis
chemical_list: D000682:Amyloid; D015415:Biomarkers; D010446:Peptide Fragments; C035222:amyloid protein AL; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain