title: Associations of N-terminal pro-B-type natriuretic peptide with kidney function decline in persons without clinical heart failure in the Heart and Soul Study.
abstract: BACKGROUND
  Subclinical volume overload in the absence of diagnosed heart failure (HF) may be an underrecognized contributor to kidney function decline in coronary artery disease (CAD) patients. We evaluated associations of circulating N-terminal pro-B-type natriuretic peptide (NT-proBNP), a marker of ventricular stretch, with change in estimated glomerular filtration rate (eGFR).
  
  
  METHODS
  We evaluated 535 patients with stable CAD and no history of HF, who were enrolled in the Heart and Soul Study and followed for 5 years. N-terminal pro-B-type natriuretic peptide was measured at baseline. We evaluated the associations of NT-proBNP with change in kidney function over 5 years: (a) annual percent change in eGFR, (b) rapid kidney function loss (> 3% per year for 5 years), and (c) incident eGFR < 60 mL/min per 1.73 m2. In multivariable models, we adjusted for demographics, comorbid conditions, echocardiographic parameters, medications, and baseline kidney function.
  
  
  RESULTS
  Among 535 participants, median NT-proBNP was 130.6 (interquartile range 61.8-280.9) pg/mL, and median B-type natriuretic peptide (BNP) was 32.5 (14.4-75.9) pg/mL. Individuals with NT-proBNP levels in the highest quartile (> 280.9 pg/mL) had a greater odds of rapid kidney function loss after full adjustment (odds ratio 2.95; 95% CI 1-8.65; P = .0492). Associations with incident eGFR < 60 mL/min per 1.73 m2 were also significant (adjusted odds ratio 4.23; 95% CI 1.05-16.98; P = .0422). Results were similar when analyzed using BNP as the predictor.
  
  
  CONCLUSIONS
  N-terminal pro-B-type natriuretic peptide and BNP are strongly and independently associated with accelerated kidney function loss, even in the absence of clinical HF. These findings suggest that subclinical cardiovascular dysfunction may contribute to elevated kidney disease risk in persons with CAD.
authors.affiliation: University of California, San Francisco, Division of Nephrology, San Francisco, CA. Electronic address: meyeon.park@ucsf.edu.
authors.forename: Meyeon
authors.initials: M
authors.lastname: Park
authors.affiliation: University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of California, San Francisco, Department of Medicine, San Francisco, CA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of California, San Francisco, Division of Cardiology, San Francisco, CA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Mishra
authors.affiliation: University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of California, San Francisco, Department of Medicine, San Francisco, CA.
authors.forename: Mary
authors.initials: M
authors.lastname: Whooley
authors.affiliation: University of Washington, Division of Nephrology, Seattle, WA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D017597:Renal Blood Flow, Effective; D051437:Renal Insufficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D016276:Ventricular Function / Q000502:physiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain