In the present study, we investigated the potential of N-BNP (N-terminal B-type natriuretic peptide) as a prognostic marker for risk of CV (cardiovascular) events, overall mortality and progression to ESRD (end-stage renal disease) in a cohort of 83 pre-dialysis CKD (chronic kidney disease) patients without clinical evidence of heart failure. During the study, ten patients reached the combined end point of overall mortality and/or CV event. Univariate factors associated with the combined end point were plasma N-BNP (P<0.0005), creatinine (P<0.002), systolic blood pressure (P<0.009) and age (P<0.015). N-BNP levels were higher in patients with CV events (P<0.0005). Cox model regression analysis yielded log10 N-BNP (hazard ratio, 9.608; P<0.007) and pre-existing CV disease (hazard ratio, 4.571; P<0.029) as independent predictors of overall mortality or CV events. Kaplan–Meier analysis curves for the subgroup with supramedian creatinine levels (225 μmol/l) showed significant separation of the curves stratified for plasma N-BNP levels above and below the group median (291 pmol/l) for all end points. Receiver-operator-characteristic curves for N-BNP (355 pmol/l cut-off) demonstrated a specificity of 65.8% at a sensitivity of 100% for predicting CV events/overall mortality. The measurement of plasma N-BNP may aid in the risk stratification of pre-dialysis CKD patients. The high sensitivity and negative predictive value (100%) may enable the selection of patients who could safely be excluded from further investigations, resulting in better focusing of resources.
Prognostic potential of brain natriuretic peptide (BNP) in predialysis chronic kidney disease patients
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Susan J. CARR, Sunita BAVANANDAN, Barbara FENTUM, Leong NG; Prognostic potential of brain natriuretic peptide (BNP) in predialysis chronic kidney disease patients. Clin Sci (Lond) 1 July 2005; 109 (1): 75–82. doi: https://doi.org/10.1042/CS20040351
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