Letter to the Editor
Value of N-terminal pro-B type natriuretic peptide assessment in patients with chronic kidney disease
Valor de la determinación de la fracción N-terminal del péptido natriurético tipo B en pacientes con enfermedad renal crónica
María Vigil-Escalera Díaza,
, Guillermo Muñiz Albaicetab,c,d, María Martín Fernándeza,c
Corresponding author
a Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
b Sección Unidad de Cuidados Críticos Cardiológicos, Servicio de Medicina Intensiva, Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
c Área de Fisiología, Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Asturias, Spain
d CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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N-terminal pro-B type natriuretic peptide assessment in patients with chronic kidney disease" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e13" "paginaFinal" => "e14" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Vigil-Escalera Díaz, Guillermo Muñiz Albaiceta, María Martín Fernández" "autores" => array:3 [ 0 => array:4 [ "nombre" => "María" "apellidos" => "Vigil-Escalera Díaz" "email" => array:1 [ 0 => "mariavigilescalera@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Guillermo" "apellidos" => "Muñiz Albaiceta" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "María" "apellidos" => "Martín Fernández" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección Unidad de Cuidados Críticos Cardiológicos, Servicio de Medicina Intensiva, Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Área de Fisiología, Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Asturias, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor de la determinación de la fracción N-terminal del péptido natriurético tipo B en pacientes con enfermedad renal crónica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have thoroughly read the original article recently published in your journal by García et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> as well as the letter to the editor by Tazón-Varela et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In previous issues of your journal, a matter that we believe as clinically relevant has been mentioned. 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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">3–5</span></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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">100 patients were included (73% males, median age: 69 [61–78]). The average glomerular filtration rate was 30<span class="elsevierStyleHsp" style=""></span>ml/min (SD: 21.7; CKD stages: 1<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10.5%; 2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.1%; 3a<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9.5%; 3b<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18.9%; 4<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21.1% and 5<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>38.9%). 16% were on a hemodialysis program and 15% on peritoneal dialysis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">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>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">In the logistic regression model, only NT-proBNP showed statistical significance (OR: 1.04 [1.01–1.07] for every 1000<span class="elsevierStyleHsp" style=""></span>pg/ml increase; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.00033). The area under the curve was 0.82.</p><p id="par0045" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">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.</p>" ] ] "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" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CHF: congestive heart failure.</p>" "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"><span class="elsevierStyleItalic">p</span> 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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Significant differences in an univariate model. Median and interquartile range are listed.</p>" ] ] ] "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. 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| 2023 March | 3 | 2 | 5 |
