title: Clinical Value of Natriuretic Peptides in Predicting Time to Dialysis in Stage 4 and 5 Chronic Kidney Disease Patients.
abstract: BACKGROUND
  Anticipating the time to renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is an important but challenging issue. Natriuretic peptides are biomarkers of ventricular dysfunction related to poor outcome in CKD. We comparatively investigated the value of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as prognostic markers for the risk of RRT in stage 4 and 5 CKD patients, and in foretelling all-cause mortality and major cardiovascular events within a 5-year follow-up period.
  
  
  METHODS
  Baseline plasma BNP (Triage, Biosite) and NT-proBNP (Elecsys, Roche) were measured at inclusion. Forty-three patients were followed-up during 5 years. Kaplan-Meier analysis, with log-rank testing and hazard ratios (HR), were calculated to evaluate survival without RRT, cardiovascular events or mortality. The independent prognostic value of the biomarkers was estimated in separate Cox multivariate analysis, including estimated glomerular filtration rate (eGFR), creatininemia and comorbidities.
  
  
  RESULTS
  During the first 12-month follow-up period, 16 patients started RRT. NT-proBNP concentration was higher in patients who reached endpoint (3221 ng/L vs 777 ng/L, p = 0.02). NT-proBNP concentration > 1345 ng/L proved significant predictive value on survival analysis for cardiovascular events (p = 0.04) and dialysis within 60 months follow-up (p = 0.008). BNP concentration > 140 ng/L was an independent predictor of RRT after 12 months follow-up (p<0.005), and of significant predictive value for initiation of dialysis within 60 months follow-up.
  
  
  CONCLUSIONS
  Our results indicate a prognostic value for BNP and NT-proBNP in predicting RRT in stage 4 and 5 CKD patients, regarding both short- and long-term periods. NT-proBNP also proved a value in predicting cardiovascular events. Natriuretic peptides could be useful predictive biomarkers for therapeutic guidance in CKD.
authors.affiliation: Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France.|Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Sofia
authors.initials: S
authors.lastname: Sundqvist
authors.affiliation: Service de Biochimie, CHU Hôpitaux de Rouen, Rouen, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Larson
authors.affiliation: Service de Biochimie, CHU Hôpitaux de Rouen, Rouen, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Cauliez
authors.affiliation: Service de Cardiologie, CHU Hôpitaux de Rouen, Rouen, France.|INSERM Unité 1096, Université de Médecine-Pharmacie de Rouen, Rouen, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bauer
authors.affiliation: Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Dumont
authors.affiliation: Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Le Roy
authors.affiliation: Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Hanoy
authors.affiliation: Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Fréguin-Bouilland
authors.affiliation: Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France.|INSERM Unité 1096, Université de Médecine-Pharmacie de Rouen, Rouen, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Godin
authors.affiliation: Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France.|INSERM Unité 1096, Université de Médecine-Pharmacie de Rouen, Rouen, France.
authors.forename: Dominique
authors.identifier: http://orcid.org/0000-0001-9562-530X
authors.initials: D
authors.lastname: Guerrot
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain