Value of N-terminal pro-B type natriuretic peptide assessment in patients with chronic kidney disease

Vigil-Escalera Díaz, María; Muñiz Albaiceta, Guillermo; Martín Fernández, María

doi:10.1016/j.medcle.2018.05.050

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This is the original article written by García et al. and the letter to the editor by Tazón-Varela et al. They conclude that the plasma NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels are a good predictor of mortality in patients with sepsis (García et al.) and community-acquired pneumonia (Tazón-Varela et al.). However, they leave a question open: the value of this biomarker in patients with chronic kidney disease (CKD). Nevertheless, it is shown that in the study by García et al. it maintained independence as a predictor of mortality in the multivariate model in their study.As both point out, in CKD patients, NT-proBNP levels are significantly high, especially in patients on hemodialysis, as it is degraded by the kidney and adipose tissue (usually also reduced in these patients).<a class="elsevierStyleCrossRefs" href="#bib0040">3–5</a> This fact made us question, as well as the above mentioned authors, about its usefulness in this patient profile. Therefore, we designed a study with the purpose of assessing the association between NT-proBNP levels and the congestive heart failure (CHF) severity in patients at different CKD stages.This is a retrospective and observational study in which interconsultations from nephrology to cardiology were studied between May 2015 and March 2017 in a tertiary hospital. CHF interconsultations were classified depending on their severity (considering “severe” as the diagnosis of acute pulmonary edema or cardiogenic shock) and we assessed the association of different variables with the severity of the symptomatology, first in a univariate model and then in a multivariate regression model.100 patients were included (73% males, median age: 69 [61–78]). The average glomerular filtration rate was 30ml/min (SD: 21.7; CKD stages: 1=10.5%; 2=1.1%; 3a=9.5%; 3b=18.9%; 4=21.1% and 5=38.9%). 16% were on a hemodialysis program and 15% on peritoneal dialysis.In the univariate model, no differences were reported in the symptomatology severity of the following variables: age, previous LVEF, previous ischemic heart disease, stage of CKD, glomerular filtration rate on admission, renal replacement therapy, type of cardiorenal syndrome, previous diuretic treatment and treatment with erythropoietin or hyponatremia.NT-proBNP values and T-ultrasensitive troponin levels were significantly higher in patients with more severe CHF. On the other hand, hemoglobin (Hb) levels prior to admission were significantly lower in patients with more severe symptomatology (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In the logistic regression model, only NT-proBNP showed statistical significance (OR: 1.04 [1.01–1.07] for every 1000pg/ml increase; p=0.00033). The area under the curve was 0.82.With these findings, we can conclude that NT-proBNP does not lose any value in patients at different CKD stages to classify the severity of CHF episodes." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Vigil-Escalera Díaz M, Muñiz Albaiceta G, Martín Fernández M. Valor de la determinación de la fracción N-terminal del péptido natriurético tipo B en pacientes con enfermedad renal crónica. Med Clin (Barc). 2019;152:e13–e14." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CHF: congestive heart failure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No severe CHF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Severe CHF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Troponin T-us max, ng/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 (44–180) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">215 (149–683) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NT-proBNP, pg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7883 (2815–14,787) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70,000 (13,828–70,000) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous hemoglobin, g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.9 (10.8–13.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.9 (9.7–12.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1949194.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Significant differences in an univariate model. Median and interquartile range are listed." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[article in English, Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The NTpro-BNP is the best predictor of mortality during hospitalization in patients with low sepsis-related organ failure assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. García" 1 => "E. Bernal" 2 => "M. Egea" 3 => "I. Marin" 4 => "A. Alcaraz" 5 => "A. Munoz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2017" "volumen" => "149" "paginaInicial" => "189" "paginaFinal" => "195" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[article in English, Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The N-terminal pro brain natriuretic peptide as a predictor of mortality in patients with community acquired pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Tazón-Varela" 1 => "H. Alonso-Valle" 2 => "P. Munoz-Cacho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" "volumen" => "150" "paginaInicial" => "366" "paginaFinal" => "367" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "N-terminal-pro-Btype-natriuretic peptide associated with 2-year mortality from both cardiovascular and non-cardiovascular origins in prevalent chronic hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Ch. Kawagoe" 1 => "Y. Sato" 2 => "T. Toida" 3 => "H. Nakagawa" 4 => "Y. Yamashita" 5 => "A. Fukuda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/0886022X.2018.1437047" "Revista" => array:6 [ "tituloSerie" => "Ren Fail" "fecha" => "2018" "volumen" => "40" "paginaInicial" => "127" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29457529" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Punto de corte óptimo de NT-proBNP para el diagnóstico de insuficiencia cardiaca mediante un test de determinación rápida en atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Verdú" 1 => "J. Comín-Colet" 2 => "Domingo M." 3 => "J. Lupón" 4 => "M. Gómez" 5 => "L. Molina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.recesp.2012.01.019" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2012" "volumen" => "65" "paginaInicial" => "613" "paginaFinal" => "619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22541282" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac markers in different degrees of chronic kidney disease: influence of inflammation and previous heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Quiroga" 1 => "M. Goicoechea" 2 => "M. García de Vinuesa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2012" "volumen" => "139" "paginaInicial" => "98" "paginaFinal" => "102" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015200000003/v1_201901290746/S238702061830545X/v1_201901290746/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015200000003/v1_201901290746/S238702061830545X/v1_201901290746/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061830545X?idApp=UINPBA00004N"]

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Vol. 152. Issue 3.

Pages e13-e14 (February 2019)

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