Prognostic value of cardiac biomarkers for death in a non-dialysis chronic kidney disease population

Background. Excess mortality in patients with chronic kidney disease (CKD) is predominantly due to cardiovascular disease. We explored the prognostic value of biomarkers of cardiac overload [B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] and inflammation...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2008-11, Vol.23 (11), p.3546-3553
Main Authors: Vickery, Susan, Webb, Michelle C., Price, Christopher P., John, Robert Ian, Abbas, Nasir A., Lamb, Edmund J.
Format: Article
Language:English
Subjects:
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
B-type natriuretic peptides
Biological and medical sciences
Biomarkers - blood
C-Reactive Protein - metabolism
Chronic Disease
chronic kidney disease
Emergency and intensive care: renal failure. Dialysis management
Female
Follow-Up Studies
high-sensitivity CRP
Humans
Intensive care medicine
Kaplan-Meier Estimate
Kidney Diseases - blood
Kidney Diseases - diagnosis
Kidney Diseases - mortality
Male
Medical sciences
Middle Aged
Natriuretic Peptide, Brain - blood
Peptide Fragments - blood
Predictive Value of Tests
Prognosis
Prospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
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Summary:Background. Excess mortality in patients with chronic kidney disease (CKD) is predominantly due to cardiovascular disease. We explored the prognostic value of biomarkers of cardiac overload [B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] and inflammation [high-sensitivity C-reactive protein (hsCRP)] for all-cause mortality in patients with CKD. Methods. Plasma BNP (Siemens Medical Solutions Diagnostics, Frimley, Surrey, UK) and NT-proBNP (Roche Diagnostics PLC, East Sussex, UK), and hsCRP (Siemens Medical Solutions Diagnostics) were measured at study entry. Echocardiograms were undertaken, and left ventricular mass index (LVMI) was calculated. CKD patients (n = 213) were followed for up to 53 months. Kaplan–Meier survival analysis with log-rank testing and hazards ratios (HRs) were calculated for each cardiac biomarker, stratified by respective median values, as a predictor of death to assess outcome. Results. Fifty-four deaths occurred. NT-proBNP concentration ≥89 pmol/L (HR 5.6, P < 0.0001), BNP concentration ≥14 pmol/L (HR 3.5, P < 0.001), NT-proBNP/BNP ratio ≥6 pmol/pmol (HR 2.6, P < 0.01) and hsCRP concentration ≥4.7 mg/L (HR 2.4, P < 0.01) were unadjusted predictors of death. Only NT-proBNP ≥89 pmol/L (HR 2.5, P < 0.05) and hsCRP ≥4.7 mg/L (HR 1.9, P < 0.05) were independent predictors of death when the HRs were adjusted for significant clinical variables (age, estimated glomerular filtration rate, LVMI and vascular disease). Conclusion. NT-proBNP and hsCRP can independently predict all-cause mortality in a non-dialysis CKD population and may have a useful role in risk stratification.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfn341