B-type natriuretic peptide and prognosis of end-stage renal disease: a meta-analysis

Abstract

Background: The prognostic importance of B-type natriuretic peptide (BNP) or N-terminal pro BNP (NT-proBNP) in patients with end-stage renal disease (ESRD) remains controversial.

Methodology/principal findings: We conducted an unrestricted search from the MEDLINE and EMBASE in all languages that were published between 1966 and Augest2013. Twenty-seven long-term prospective studies met our inclusion criterias. From the pooled analysis, elevated BNP/NT-proBNP was significantly associated with increased all cause mortality [odds ratio (OR), 3.85; 95% CI, 3.11 to 4.75], cardiovascular mortality (OR, 4.05; 95% CI, 2.53 to 6.84), and cardiovascular events (OR, 7.02; 95% CI, 2.21 to 22.33). The funnel plot showed no evidence of publication bias. The corresponding pooled positive and negative likelihood ratio for prediction of all cause mortality were 1.86 (95% CI, 1.66 to 2.08) and 0.48 (95% CI, 0.42 to 0.55), respectively.

Conclusions/significance: BNP/NT-proBNP is a promising prognostic tool to risk-stratify the patients with ESRD. Further investigations are warranted to elucidate the specific pathogenic mechanisms and the impact of other potential prognostic factors.

Figure 1. Flow chart of study selection. Flow chart shows literature search for prospective studies of BNP/NT-ProBNP in relation to all-cause mortality, cardiovascular mortality and events in end stage renal disease.

Figure 2. Association between elevated BNP and all cause mortality in patients with end stage renal disease, according to different study level characteristics.

Figure 3. Summary of likelihood ratios of an elevated BNP to predict all cause mortality.

Figure 4. Begg's funnel plots with 95% CI for BNP or NT-proBNP primary studies.