J Korean Med Sci.  2009 Jan;24(Suppl 1):S63-S68. 10.3346/jkms.2009.24.S1.S63.

N-terminal Pro-Brain Natriuretic Peptide Levels Predict Left Ventricular Systolic Function in Patients with Chronic Kidney Disease

• Lee JE
• Choi SY
• Huh W
• Park SW
• Kim DJ
• Oh HY
• Kim YG

• KMID: 1778142
• DOI: http://doi.org/10.3346/jkms.2009.24.S1.S63

Abstract

N-terminal pro-brain natriuretic peptide (NT-proBNP) can be a useful marker for left ventricular (LV) dysfunction in patients without kidney disease. This study was conducted to clarify the relationship between NT-proBNP and LV systolic function in patients with decreased renal function. We studied 256 chronic kidney disease (CKD) patients, patients on dialysis were excluded. The median glomerular filtration rate was 24 (13-36) mL/min/1.73 m(2) and the median NT-proBNP was 4,849 (1,310- 19,009) pg/mL. The prevalence of LV systolic dysfunction increased from the lower to the upper NT-proBNP quartiles (I, 17%; II, 34%; III, 61%; and IV, 72%; p<0.001 for trend). The NT-proBNP quartile was an independent predictor of LV systolic dysfunction after adjustment for renal function, compared with quartile I: II, odds ratio (OR) 3.99 (95% confidence interval [CI],1.34-11.93); III, OR 11.28 (95% CI, 3.74-33.95); and IV, OR 36.97 (95% CI, 11.47-119.1). Area under the curve and optimum cut points for NT-proBNP to detect LV systolic dysfunction were 0.781 and 2,165 pg/mL in CKD stage 3, 0.812 and 4,740 pg/mL in CKD stage 4, and 0.745 and 15,892 pg/ mL in CKD stage 5. The NT-proBNP level was a predictor of LV systolic dysfunction in CKD patients. Optimum cut points should be stratified according to renal function.

Keyword

Biological Markers; Kidney Failure, Chronic; Ventricular Dysfunction, Left; Pro-brain Natriuretic Peptide (1-76)

MeSH Terms

Aged
Area Under Curve
Female
Glomerular Filtration Rate
Humans
Kidney Failure, Chronic/*complications/pathology
Male
Middle Aged
Natriuretic Peptide, Brain/*blood
Peptide Fragments/diagnostic use
Prevalence
Protein Structure, Tertiary
Sensitivity and Specificity
Ventricular Dysfunction, Left/complications/diagnosis
*Ventricular Function, Left

Figure

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  Fig. 1 Median NT-proBNP level according to left ventricular systolic function and CKD stage (p<0.01 for both inter-CKD stages and inter-LV EF groups).

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  Fig. 2 Receiver operating characteristic curves for NT-proBNP to detect LV EF ≤50% (A) and LV EF ≤40% (B) in each stages of CKD.

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