Study Explores NT-proBNP For Diagnosis in Renal Failure

Amino-terminal pro-B type natriuretic peptide (NT-proBNP) levels may be used to diagnose acute decompensated heart failure (HF) in patients with renal function, according to a study published Dec. 7 in JACC: Heart Failure.

In a systematic review and meta-analysis, Jennifer A. Shaub, MD, from Yale University School of Medicine, and colleagues examine five studies on diagnostic performance and 17 studies on prognostic ability of NT-proBNP.

They find that for diagnosing acute decompensated HF, the cutpoints in patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 were roughly two-fold higher than the cutpoints in patients with an eGFR of >60 ml/min/1.73 m2. The specificity and sensitivity were often slightly lower in patients with an eGFR of <60 compared with patients with an eGFR of >60. The unadjusted pooled relative risk was 3.01 (95 percent CI: 2.53 to 3.58) when comparing patients with preserved renal function and elevated NT-proBNP to patients with preserved renal function and normal NT-proBNP.

In addition, the pooled risk ratio for patients with renal dysfunction was 3.25 (95 percent CI: 2.45 to 4.30), although there was a higher event rate (20.9 percent) than patients with preserved renal function (11.9 percent). The pooled risk ratios between patients with preserved and diminished renal function were not different (p=0.652). In the studies that provided adjusted estimates for the association between NT-proBNP and mortality, the pooled risk ratios for patients with preserved and diminished renal function were similar, and there was no significant difference between the two groups (p=0.141).

The authors report that these findings demonstrate that NT-proBNP is useful for diagnosis of acute decompensated HF or prognosis in patients with renal dysfunction, even though these patients have higher plasma levels of NT-proBNP. As the cutpoints varied in the included studies, moving forward, the researchers encourage future studies be aimed at patients with renal dysfunction to help identify more precise cutpoints.

“We have been concerned for some time as to whether the natriuretic peptide levels portray the same prognostic information in acute HF patients with renal dysfunction,” says Christopher O’Connor, MD, FACC, editor-in-chief of JACC: Heart Failure. “This report by Shaub, et al., highlights the significant value of NT-proBNP in acute decompensated HF patients regardless of renal function. This study broadens our understanding of risk and hopefully will lead to improved outcomes for our patients.”

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Glomerular Filtration Rate, Heart Failure, Natriuretic Peptide, Brain, Natriuretic Peptides, Peptide Fragments, Renal Insufficiency

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