Exploring the relation between changes in NT-proBNP and renal function in patients with suspected heart failure using structural equation modelling.
BACKGROUND
The relation between changes in NT-proBNP and renal function has commonly been studied using multiple regressions, which may ignore the complexity of relations between related variables.


RESULTS
Data were collected from patients referred with suspected heart failure (HF) to a community service. Structural equation modelling (SEM) was used to assess the association between changes in NT-proBNP at 1year, and other pre-specified variables including age, sex, BMI, eGFR, loop diuretics and ACE inhibitor. Of 1006 patients with a follow-up NT-proBNP at 1year, 882 (88%) had HF. The baseline median age was 72 (IQR: 63-78) years, 732 (73%) were men, 668 (66%) had left ventricular systolic dysfunction and 769 (76%) had NT-proBNP>400pg/ml. For all patients at 1year, 243 (24%) patients had at least a 50% reduction in NT-proBNP, and 199 (20%) had at least a 50% increase, only 40 (3%) had <3% change. Change in NT-proBNP was strongly associated with baseline NT-proBNP (the standardized coefficient (r)=0.73, p<0.001). The change in NT-proBNP was not associated with changes in eGFR, and was indirectly related with age, BMI, eGFR and loop diuretics (p<0.01 for all).


CONCLUSIONS
Baseline NT-proBNP was the main determinant of change in NT-proBNP at one year.
Department of Academic Cardiology, Castle Hill Hospital, Hull, UK; Faculty of Medical Science, Anglia Ruskin Universality, UK. Electronic address: Jufen.Zhang@anglia.ac.uk.
Jufen
J
Zhang
Department of Academic Cardiology, Castle Hill Hospital, Hull, UK.
Kenneth Y-K
KY
Wong
Department of Academic Cardiology, Castle Hill Hospital, Hull, UK.
Andrew L
AL
Clark
National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK.
John G F
JG
Cleland
D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013318:Stroke Volume / Q000502:physiology*; D006113:United Kingdom / Q000453:epidemiology
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
Change in NT-proBNP; Renal function; Suspected heart failure