NT-proBNP as a Predictor of Heart Failure in Patients with Chronic Kidney Disease

Although N-terminal pro-B-type natriuretic peptide (NT-proBNP) can predict heart failure (HF) in the general population, investigators sought to find out if NT-proBNP could be used to predict HF in patients with mild to severe chronic kidney disease (CKD).  In a study published in the October issue of the Journal of the American Society of Nephrology, Bansal and colleagues conducted a prospective analysis of 3483 subjects with CKD in the Chronic Renal Insufficiency Cohort (CRIC) study, who were recruited between June 2003 and August 2008.  None of these subjects had HF at baseline.  The investigators made adjustments for markers of both mineral metabolism and kidney disease, as well as medications, demographic factors, and traditional cardiovascular risk factors.  They divided subjects into quintiles for NT-proBNP and found that subjects with the lowest levels (<47.6 ng/ml) had a significantly higher rate of heart failure than those in the highest quintile (>433.0 ng/ml).  In this study, the authors found that both NT-proBNP and high-sensitivity troponin (hsTnT) in patients with all levels of CKD were strongly associated with incident heart failure.  The investigators postulated that the NT-proBNP elevations were possibly linked to subclinical changes in myocardial stress that can lead to heart failure.

Reference: Bansal N, Anderson AH, Yang W, et al. High-sensitivity troponin T and N-terminal natriuretic peptide (NT-proBNP) and risk of incident heart failure in patients with CKD: the chronic renal insufficiency cohort (CRIC) study. J Am Soc Neph 2014: Published online before print October 2, 2014, doi: 10.1681/ASN.2014010108 JASN

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