Plasma Levels of N-terminal pro-brain Natriuretic Peptide (NT-proBNP) and Left Ventricular Function in Patients with Chronic Renal Failure

Choi, So Yeon; Kim, Jung Ah; Lee, Jung Eun; Do, Yeon Sil; Jang, Eun Hee; Bae, Hyun Jeong; Kim, Jung In; Do, Jung Ho; Choi, Sung Chul; Kim, Dae Joong; Huh, Wooseong; Oh, Ha Young; Park, Seung Woo; Jeon, Eunseok; Ki, Chang Seok; Kim, Yoon Goo

Abstract

BACKGROUND: Circulating levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) have been used to identify and monitor myocardial dysfunction in patients with various cardiac diseases. However, its clinical significance in patients with chronic renal failure (CRF) is uncertain because NT-proBNP clearance may be affected by renal function.
METHODS
We studied 331 patients with CRF (eGFR <60 mL/min/1.73m2) admitted to Samsung Medical Center between March 2003 and March 2005, in whom both NT-proBNP measurement and echocardiography were performed within a week.
RESULTS
Mean value of eGFR was 29+/-15 mL/ min/1.73m2 and median value of NT-proBNP was 6,971 pg/mL. NT-proBNP levels increased with declining eGFR (p<0.05). NT-proBNP levels were also elevated in patients with left ventricular hypertrophy (LVH), systolic dysfunction and diastolic dysfunction. In multiple regression analysis, ejection fraction (beta=-0.373, p>0.01) was strong independent correlate of NT-proBNP, eGFR (beta=-0.358, p<0.01), left ventricular mass index (beta=0.126, p>0.01) and diastolic dysfunction 2 or higher (beta=0.171, p< 0.05) were also independent correlates of NT-proBNP. Receiver-operating characteristic (ROC) analyses demonstrated NT-proBNP to be 75% sensitive and 76% specific for the detection of left ventricular systolic dysfunction, as indicated by area under the ROC curve of 0.78 (p<0.05), with NT-proBNP cutoff concentration of 25,000 pg/mL.
CONCLUSION
Circulating NT-proBNP levels increased with declining renal function. However, its level were significantly correlated with LVH, systolic and diastolic dysfunction in patients with CRF. The measurement of NT-proBNP levels might be useful to predict left ventricular dysfunction in patients with CRF.