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. 2008 Dec;23(4):191-200.
doi: 10.3904/kjim.2008.23.4.191.

Relationship between serum brain natriuretic peptide and heart function in patients with chronic kidney disease

Jae Won Yang  1 , Min Soo Kim, Jae Seok Kim, Jong Myoung Yoo, Seung Tae Han, Bi Ro Kim, Yun Deok Kim, Jeong Wook Choi, Seung Ok Choi, Byoung Geun Han
Affiliations

Relationship between serum brain natriuretic peptide and heart function in patients with chronic kidney disease

Jae Won Yang et al. Korean J Intern Med. 2008 Dec.

Abstract

Background/aims: Brain natriuretic peptide (BNP) levels are known to be elevated in patients with chronic kidney disease (CKD) and normal heart function. Therefore, the present study was performed to examine the effectiveness of BNP level in diagnosing heart failure in patients with CKD and to determine its effects on survival rate and prognosis.

Methods: A total of 182 patients with CKD who visited the hospital due to dyspnea of NYHA class II were included in the study. BNP levels were measured and echocardiography was performed to divide the subjects into groups with and without heart failure. Their BNP levels, clinical courses, and survival rates were analyzed retrospectively.

Results: When BNP level was >/=858.5 pg/mL in CKD patients, heart failure could be diagnosed with sensitivity and specificity of 77% and 72%, respectively. Survival rate of the group with BNP levels of >/=858.8 pg/mL was significantly lower than that of the group with BNP level below this threshold (p=0.012) and multivariate analysis showed that BNP level, age, and sex affected survival rate in the group with BNP level >/=858.8 pg/mL.

Conclusions: BNP levels of patients with CKD showed a positive correlation with creatinine levels, and the critical point of BNP level for diagnosis of heart failure was 858.5 pg/mL. As the survival rate in patients with BNP level above the critical point was significantly low, this level was a useful indicator for predicting their prognosis. Care should be taken in interpreting BNP level because patients with stage 5 CKD may show a high concentration of BNP without heart failure.

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Figures

Figure 1
Figure 1
The classification of all patients.
Figure 2
Figure 2
Box plot of serum BNP levels in CKD stage 3 (A), CKD stage 4 (B), and stage 5 (C) according to heart function.
Figure 3
Figure 3
Scatter plots of log BNP with ejection fraction (A) and duration of survival (B).
Figure 4
Figure 4
The accuracy and reference value of serum BNP for diagnosing CHF in all patients (A), in CKD stage 3-4 (B), and CKD stage 5 (C) by ROC curve.
Figure 5
Figure 5
The cumulative survival rate using Kaplan-Meier method in patients with CKD stage 3-5 (A) and with renal replacement treatment (B) classified according to serum BNP level.
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