title: Efficacy of N-terminal pro-brain natriuretic peptide digit number for screening of cardiac disease in new haemodialysis patients.
abstract: OBJECTIVE
  The usefulness of the absolute N-terminal pro-brain natriuretic peptide (NT-ProBNP) concentration and its digit number for screening for cardiac disease was explored in new haemodialysis patients.
  
  
  METHODS
  A cross-sectional study involving 71 (68 ± 14 years, 83% male) new dialysis patients was conducted. Receiver operator characteristic curve analysis was performed to identify the cutoff level of NT-proBNP for identifying cardiac disease at the start of dialysis.
  
  
  RESULTS
  The median NT-proBNP concentration was 6576 pg/mL just before the first dialysis session and its mean digit number was 4.3 ± 0.6. Overall, 67%, 52%, 9% and 35% of patients had left ventricular (LV) hypertrophy, LV dilatation, systolic dysfunction and significant coronary artery disease, respectively. NT-proBNP levels of about 6000, 10,000 and 14,000 pg/mL were the best cutoff levels for the diagnosis of coronary artery disease (AUC, 0.754; P < 0.001), LV systolic dysfunction (area under the curve (AUC), 0.765, P = 0.001) and LV dilatation (AUC, 0.685, P = 0.008), respectively. Interestingly, 4.5 was the best digit number cutoff for all cardiac abnormalities. These findings suggest that a digit number of 5 or more means a potentially high risk for cardiovascular disease and a digit number of 3 or less means a relatively low risk.
  
  
  CONCLUSIONS
  The NT-proBNP concentration just before the first dialysis session is a useful tool for screening for cardiac abnormalities. Considering the wide variation of the NT-proBNP cutoff levels depending on each cardiac abnormality, the digit number could be potentially easier to use for initial risk stratification for cardiac disease in new dialysis patients.
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Joki
authors.forename: Yuri
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Ikeda
authors.forename: Toshihide
authors.initials: T
authors.lastname: Hayashi
authors.forename: Shun
authors.initials: S
authors.lastname: Kubo
authors.forename: Takasuke
authors.initials: T
authors.lastname: Asakawa
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirahata
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Imamura
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hase
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000175:diagnosis; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D015854:Up-Regulation; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain