title: Amino-Terminal Pro-B-Type Natriuretic Peptide for Diagnosis and Prognosis in Patients With Renal Dysfunction: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  This study sought to determine if amino-terminal pro-B-type natriuretic peptide (NT-proBNP) has different diagnostic and prognostic utility in patients with renal dysfunction.
  
  
  BACKGROUND
  Patients with renal dysfunction have higher NT-proBNP, which may complicate interpretation for diagnosis of acute decompensated heart failure (ADHF) or prognosis.
  
  
  METHODS
  We searched MEDLINE and EMBASE through August 2014 for studies with a subgroup analysis by renal function of the diagnostic or prognostic ability of NT-proBNP.
  
  
  RESULTS
  For diagnosis, 9 studies were included with 4,287 patients and 1,325 ADHF events. Patients were mostly divided into subgroups with and without renal dysfunction by an estimated glomerular filtration rate of 60 ml/min/1.73 m(2). In patients with renal dysfunction, the area under the curve (AUC) for NT-proBNP ranged from 0.66 to 0.89 with a median cutpoint of 1,980 pg/ml, while the AUC ranged from 0.72 to 0.95 with a cutpoint of 450 pg/ml in patients with preserved renal function. For prognosis, 30 studies with 32,203 patients were included, and mortality in patients with renal dysfunction (25.4%) was twice that of patients with preserved renal function (12.2%). The unadjusted pooled risk ratio for NT-proBNP and mortality was 3.01 (95% confidence interval [CI]: 2.53 to 3.58) in patients with preserved renal function and was similar in patients with renal dysfunction (3.25; 95% CI: 2.45 to 4.30). Upon meta-regression, heterogeneity was partially explained if patients with heart failure or coronary artery disease were enrolled.
  
  
  CONCLUSIONS
  NT-proBNP retains utility for diagnosis of ADHF in patients with renal dysfunction with higher cutpoints. Elevated NT-proBNP confers a worse prognosis regardless of renal function.
authors.affiliation: Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Schaub
authors.affiliation: Ichan School of Medicine at Mount Sinai, New York, New York.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.affiliation: Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Dennis G
authors.initials: DG
authors.lastname: Moledina
authors.affiliation: John Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven.
authors.forename: Mark
authors.initials: M
authors.lastname: Gentry
authors.affiliation: Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
authors.affiliation: Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut. Electronic address: chirag.parikh@yale.edu.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D015415:Biomarkers / Q000097:blood; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: amino-terminal pro-B-type natriuretic peptide; diagnosis; prognosis; renal dysfunction