title: Prognostic value of plasma renin activity in heart failure patients with chronic kidney disease.
abstract: BACKGROUND
  Impairment of kidney function is frequently observed in chronic heart failure (CHF). It correlates with clinical and neurohormonal status, and affects prognosis. We aimed to identify the prognostic impact of plasma renin activity (PRA) in patients affected by CHF with chronic kidney disease (CKD).
  
  
  METHODS
  We enrolled 996 consecutive CHF patients (age 65 ± 13 years, mean ± SD, left ventricular ejection fraction, LVEF, 33 ± 10%), who underwent a complete clinical and neurohormonal characterization and were then followed-up (median 36 months) for the end point of cardiac death.
  
  
  RESULTS
  A stage ≥ 3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m(2)) was found in 437 patients. Impaired renal function was associated with worse symptoms, lower LVEF, higher plasma norepinephrine, NT-proBNP and PRA (all p<0.001). As compared to patients with preserved renal function, those with CKD had higher cardiac mortality [106 (24%) vs 53 (9.5%), p<0.001]. In CKD patients, at Cox multivariate analysis, only ejection fraction (HR 0.91, 95% CI 0.84-0.97, p=0.008), NT-proBNP (2.53, 1.45-4.41, p=0.001) and PRA (1.73, 1.16-2.58, p=0.007) were independent predictors of cardiac death. ROC analysis identified a cut-off value for PRA of 3.29 ng/mL/h that predicted prognosis with the greatest accuracy. Finally, the elevation of both NT-proBNP and PRA identified a subset of patients with the highest risk of cardiac death.
  
  
  CONCLUSIONS
  PRA has an independent prognostic value in CHF patients with CKD comorbidity. The combination of PRA and NT-proBNP identifies a group of high risk patients, who might benefit of a more intensive care, targeted to enhance renin-angiotensin system antagonism.
authors.affiliation: Division of Cardiovascular Medicine, Fondazione G. Monasterio, CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy. poletti@ftgm.it
authors.forename: Roberta
authors.initials: R
authors.lastname: Poletti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vergaro
authors.forename: Luc
authors.initials: L
authors.lastname: Zyw
authors.forename: Concetta
authors.initials: C
authors.lastname: Prontera
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D012083:Renin / Q000097:blood*; D015996:Survival Rate / Q000639:trends; D000092502:Renin Inhibitors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D012083:Renin; D000092502:Renin Inhibitors; C109794:pro-brain natriuretic peptide (1-76)