N-terminal pro-B-type natriuretic peptide (NT-proBNP) assessment in the first year after renal transplantation and its relationship with graft function and left ventricular hypertrophy.
BACKGROUND
NT-proBNP is a natriuretic neurohormone released mainly from ventricular cardiomyocytes in conditions of volumetric or pressure overload; it is suitable for use as a marker of left ventricular hypertrophy (LVH), a common disorder in renal transplant recipients. The study objective here was to assess NT-proBNP levels in the 1st year after renal transplantation (RT) and its relationship with graft function and LVH.


METHODS
Sixty patients (age, 49 ± 16.9 y; male, 58%) were subjected to prospective 1-year follow-up. Basic blood tests and NT-proBNP level measurements were performed twice (in the early period and at 1 year after transplantation). Cardiac echography was performed in 40 patients. LVH was diagnosed when left ventricular mass index was >95 g/m(2) in women and >115 g/m(2) in men. Statistical analyses were performed with the use of the R Package.


RESULTS
At 1 year after RT, the NT-proBNP level decreased >2-fold compared with the early period (median 171 pg/mL [interquartile range (IQR), 104.5-283] vs 368 pg/mL[IQR, 170-629]; P = .00008). In the early post-transplantation period, NT-proBNP correlated with the patient's age, body mass index, estimated glomerular filtration rate (eGFR), and left ventricular end-diastolic dimension, and at 1 year after transplantation its correlation with the eGFR range (patients with eGFR ≥60 mL min(-1) 1.73 m(-2) had significantly lower NT-proBNP levels than those with eGFR <60 mL min(-1) 1.73 m(-2)), with age,and with ejection fraction was found. Patients with LVH had higher NT-proBNP levels than those without LVH in the early period (median 511 pg/mL [IQR, 190-736] vs 380 pg/mL [IQR, 217-511]; P = .09), and at 1 year (median 269 pg/mL [IQR, 155-474] vs 133 pg/mL [IQR, 99-134]; P = .057). At NT-proBNP >480 pg/mL in the early period and >280 pg/mL at 1 year, LVH occurred with a 68% probability (P = .05 and P = .03, respectively).


CONCLUSIONS
During the 1st year after RT, NT-proBNP levels decrease ≥2-fold and are primarily related to eGFR. NT-proBNP measurements are useful in identifying patients with LVH.
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Warsaw Medical University, Warszawa, Poland. Electronic address: kslub@wp.pl.
K
K
Slubowska
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Warsaw Medical University, Warszawa, Poland.
A
A
Sadowska
Department of General and Transplant Surgery, Transplantation Institute, Warsaw Medical University, Warszawa, Poland.
A
A
Kwiatkowski
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Warsaw Medical University, Warszawa, Poland.
M
M
Durlik
D000328:Adult; D000368:Aged; D064591:Allografts / Q000502:physiology*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D007668:Kidney / Q000502:physiology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D017063:Outcome Assessment, Health Care; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D011446:Prospective Studies; D014463:Ultrasonography
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain