Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2008 Nov;3(6):1644-51.
doi: 10.2215/CJN.00850208. Epub 2008 Jul 16.

Natriuretic peptides in chronic kidney disease

Rajat Tagore  1 , Lieng H Ling, Hong Yang, Hla-Yee Daw, Yiong-Huak Chan, Sunil K Sethi
Affiliations
Comparative Study

Natriuretic peptides in chronic kidney disease

Rajat Tagore et al. Clin J Am Soc Nephrol. 2008 Nov.

Abstract

Background and objectives: B-type natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) are biomarkers of cardiovascular disease that is common in patients with chronic kidney disease (CKD). Conflicting data on the influence of glomerular filtration rate (GFR) on BNP and NT-proBNP levels in CKD may stem from failure to account fully for the effects of coexistent cardiac disease, dysfunction, and volume overload.

Design, setting, participants, & measurements: Prospective head-to-head comparison of plasma BNP and NT-proBNP in ambulatory euvolemic CKD patients with normal LV ejection fraction and no manifest cardiac or vascular disease. GFR was estimated by the Modification of Diet in Renal Disease formula, BNP and NT-proBNP measured using Abbott AxSYM and Roche Elecsys assays, respectively, and cardiac morphology and function assessed by transthoracic echocardiography.

Results: In 142 patients (42% female) of mean age 60 +/- 11 yr, mean left ventricular ejection fraction was 71% +/- 6%, GFR 38 +/- 14 ml/min per 1.73 m(2), and median BNP and NT-proBNP level 59 and 311 pg/ml, respectively. Multivariate predictors of NT-proBNP level were GFR, beta-blocker usage, LV mass index, and hemoglobin level. Plasma BNP was independently predicted by LV mass index and beta-blocker usage but not GFR. In the 74 patients without diastolic dysfunction, there was a significant rise in NT-proBNP but not BNP as GFR declined.

Conclusions: Unlike NT-proBNP, plasma BNP level is relatively independent of GFR. BNP may therefore be the more appropriate biomarker to screen for cardiac dysfunction in CKD.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Scatter plot of plasma B-type natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations in relation to MDRD-estimated glomerular filtration rate (GFR). Lines of best linear fit are shown.
Figure 2.
Figure 2.
Three-dimensional bar graphs of median levels of B-type natriuretic peptide (BNP, left panel) and N-terminal pro-B-type natriuretic peptide (NT-proBNP, right panel) versus glomerular filtration rate (GFR, expressed in ml/min per 1.73 m2) and diastolic dysfunction grade.
See this image and copyright information in PMC

References

    1. Daniels LB, Maisel AS: Natriuretic peptides. J Am Coll Cardiol 50: 2357–2368, 2007 - PubMed
    1. Korenstein D, Wisnivesky JP, Wyer P, Adler R, Ponieman D, McGinn T: The utility of B-type natriuretic peptide in the diagnosis of heart failure in the emergency department: a systematic review. BMC Emerg Med 7: 6, 2007 - PMC - PubMed
    1. Fuat A, Murphy JJ, Hungin AP, Curry J, Mehrzad AA, Hetherington A, Johnston JI, Smellie WS, Duffy V, Cawley P: The diagnostic accuracy and utility of a B-type natriuretic peptide test in a community population of patients with suspected heart failure. Br J Gen Pract 56: 327–333, 2006 - PMC - PubMed
    1. Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT, Meverden RA, Roger VL: Systolic and diastolic heart failure in the community. JAMA 296: 2209–2216, 2006 - PubMed
    1. McCullough PA, Duc P, Omland T, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Westheim A, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS: B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis 41: 571–579, 2003 - PubMed

Publication types

MeSH terms