title: Prognostic value of B-type natriuretic peptide and its amino-terminal proBNP fragment for cardiovascular events with stratification by renal function.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) are useful biomarkers for diagnosis and prediction of prognosis. Both of these peptides are elevated in patients with chronic kidney disease (CKD), but there is no evidence as to which peptide is the more suitable biomarker in patients with severe renal dysfunction.
  
  
  RESULTS
  This retrospective cohort study evaluated patients with cardiovascular diseases (64.9±11.7 years, mean±SD). The end points were all-cause death and a composite end point of all-cause death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for severe heart failure, and initiation of hemodialysis. Baseline plasma BNP and NT-proBNP levels, expressed as log-transformed data, were closely correlated in patients with CKD stages 1-3 (n=998) (r2=0.870, p<0.001), whereas for CKD stages 4-5 (n=85) there was a significant but weaker correlation (r2=0.209, p<0.001). During follow-up periods (51.3±0.4 months), 132 patients died and 202 patients reached the composite end point. The area under the receiver operating characteristic curve (AUROC) for BNP and NT-proBNP were similar for CKD stages 1-3. However, for CKD stages 4-5, the AUC for mortality for BNP was 0.713 and that for NT-proBNP was 0.760, while the AUC for the composite end point for BNP was 0.666 and that for NT-proBNP was 0.720.
  
  
  CONCLUSIONS
  Both BNP and NT-proBNP are useful biomarkers for mortality and cardiovascular events, but NT-proBNP may be superior to BNP for CKD stages 4-5.
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Horii
authors.forename: Takaki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Yu
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takitsume
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ueda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Taku
authors.initials: T
authors.lastname: Nishida
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okayama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Somekawa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ishigami
authors.forename: Yukiji
authors.initials: Y
authors.lastname: Takeda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawata
authors.forename: Rika
authors.initials: R
authors.lastname: Kawakami
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain