eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
5/2018
vol. 14
 
Share:
Share:
more
 
 
abstract:
Clinical research

The role of B-type natriuretic peptide in diagnosing acute decompensated heart failure in chronic kidney disease patients

Amer N. Kadri, Roop Kaw, Yasser Al-Khadra, Hasan Abumasha, Keyvan Ravakhah, Adrian V. Hernandez, Wai Hong Wilson Tang

Arch Med Sci 2018; 14, 5: 1003–1009
Online publish date: 2018/08/13
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Introduction
Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type natriuretic peptide (BNP), which alters the test interpretation. We aim to define BNP cutoff levels to diagnose acute decompensated heart failure (ADHF) in CKD according to CHF subtype: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).

Material and methods
We reviewed 1,437 charts of consecutive patients who were admitted for dyspnea. We excluded patients with normal kidney function, without measured BNP, echocardiography, or history of CHF. BNP cutoff values to diagnose ADHF for CKD stages according to CHF subtype were obtained for the highest pair of sensitivity (Sn) and specificity (Sp). We calculated positive and negative likelihood ratios (LR+ and LR–, respectively), and diagnostic odds ratios (DOR), as well as the area under the receiver operating characteristic curves (AUC) for BNP.

Results
We evaluated a  cohort of 348 consecutive patients: 152 had ADHF, and 196 had stable CHF. In those with HFpEF with CKD stages 3–4, BNP < 155 pg/ml rules out ADHF (Sn90%, LR– = 0.26 and DOR = 5.75), and BNP > 670 pg/ml rules in ADHF (Sp90%, LR+ = 4 and DOR = 6), with an AUC = 0.79 (95% CI: 0.71–0.87). In contrast, in those with HFrEF with CKD stages 3–4, BNP < 412.5 pg/ml rules out ADHF (Sn90%, LR– = 0.19 and DOR = 9.37), and BNP > 1166.5 pg/ml rules in ADHF (Sp87%, LR+ = 3.9 and DOR = 6.97) with an AUC = 0.78 (95% CI: 0.69–0.86). All LRs and DOR were statistically significant.

Conclusions
BNP cutoff values for the diagnosis of ADHF in HFrEF were higher than those in HFpEF across CKD stages 3–4, with moderate discriminatory diagnostic ability.

keywords:

acute decompensated heart failure, B-type natriuretic peptide, chronic kidney disease, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction

references:
Vanderheyden M, Bartunek J, Filippatos G, Goethals M, Van Vlem B, Maisel A. Cardiovascular disease in patients with chronic renal impairment: role of natriuretic peptides. Congest Heart Fail 2008; 14: 38-42.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-305.
Schaub JA, Coca SG, Moledina DG, Gentry M, Testani JM, Parikh CR. Amino-terminal pro-B-type natriuretic peptide for diagnosis and prognosis in patients with renal dysfunction: a systematic review and meta-analysis. JACC Hear Fail 2015; 3: 977-89.
Francis GS, Felker GM, Tang WHW. A test in context: critical evaluation of natriuretic peptide testing in heart failure. J Am Coll Cardiol 2016; 67: 330-7.
Zhu WH, Chen LY, Dai HL, Chen JH, Chen Y, Fang LZ. Correlation between B type natriuretic peptide and metabolic risk factors. Arch Med Sci 2016; 12: 334-40.
Feola M, Lombardo E, Testa M, Avogadri E, Piccolo S, Vado A. Prognostic factors of mid-term clinical outcome in congestive heart failure patients discharged after acute decompensation. Arch Med Sci 2012; 8: 462-70.
Karasek D, Sinkiewicz W, Błażejewski J. Relationship between B-type natriuretic peptide serum level, echocardiographic TEI index and the degree of diastolic dysfunction in patients with heart failure with preserved systolic function. Arch Med Sci 2011; 7: 449-56.
McCullough PA, Duc P, Omland T, et al. 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 2003; 41: 571-9.
Niizuma S, Iwanaga Y, Yahata T, et al. Impact of left ventricular end-diastolic wall stress on plasma B-type natriuretic peptide in heart failure with chronic kidney disease and end-stage renal disease. Clin Chem 2009; 55: 1347-53.
Jafri L, Kashif W, Tai J, et al. B-type natriuretic peptide versus amino terminal pro-B type natriuretic peptide: selecting the optimal heart failure marker in patients with impaired kidney function. BMC Nephrol 2013; 14: 117.
Yang JW, Kim MS, Kim JS, et al. Relationship between serum brain natriuretic peptide and heart function in patients with chronic kidney disease. Korean J Intern Med 2008; 23: 191-200.
Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161-7.
Maisel AS, McCord J, Nowak RM, et al. Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction: results from the breathing not properly multinational study. J Am Coll Cardiol 2003; 41: 2010-7.
Jaubert MP, Armero S, Bonello L, et al. Predictors of B-type natriuretic peptide and left atrial volume index in patients with preserved left ventricular systolic function: an echocardiographic-catheterization study. Arch Cardiovasc Dis 2010; 103: 3-9.
Tate S, Griem A, Durbin-Johnson B, Watt C, Schaefer S. Marked elevation of B-type natriuretic peptide in patients with heart failure and preserved ejection fraction. J Biomed Res 2014; 28: 255-61.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int 2009; 76: S1-2.
Buckley MG, Sethi D, Markandu ND, Sagnella GA, Singer DR, MacGregor GA. Plasma concentrations and comparisons of brain natriuretic peptide and atrial natriuretic peptide in normal subjects, cardiac transplant recipients and patients with dialysis-independent or dialysis-dependent chronic renal failure. Clin Sci 1992; 83: 437-44.
Nomura H, Hayashi T, Esaki T, et al. Standardization of plasma brain natriuretic peptide concentrations in older Japanese – relationship to latent renal dysfunction and ischemic heart disease. J Am Geriatr Soc 2002; 50: 1504-9.
Takami Y, Horio T, Iwashima Y, et al. Diagnostic and prognostic value of plasma brain natriuretic peptide in non-dialysis-dependent CRF. Am J Kidney Dis 2004; 44: 420-8.
GA. Measurement and significance of circulating natriuretic peptides in cardiovascular disease. Clin Sci 1998; 95: 519-29.
Tsutamoto T, Wada A, Sakai H, et al. Relationship between renal function and plasma brain natriuretic peptide in patients with heart failure. J Am Coll Cardiol 2006; 47: 582-6.
Akiba T, Tachibana K, Togashi K, Hiroe M, Marumo F. Plasma human brain natriuretic peptide in chronic renal failure. Clin Nephrol 1995; 44: S61-4.
Gupta DK, Daniels LB, Cheng S, Criqui MH, Maisel AS, Lima JA. Differences in natriuretic peptide levels by race/ethnicity (from the multi-ethnic study of atherosclerosis). Am J Cardiol 2017; 120: 1008-15.
Yandrapalli S, Aronow WS, Mondal P, Chabbott DR. The evolution of natriuretic peptide augmentation in management of heart failure and the role of sacubitril/valsartan. Arch Med Sci 2017; 13: 1207-16.
Vasan RS, Xanthakis V, Lyass A, et al. Epidemiology of left ventricular systolic dysfunction and heart failure in the Framingham study: an echocardiographic study over 3 decades. JACC: cardiovascular imaging. JACC Cardiovasc Imaging 2018; 11: 1-11.
Gupta DK, Shah AM, Castagno D, et al. Heart failure with preserved ejection fraction in African Americans: the ARIC (Atherosclerosis Risk In Communities) study. JACC Hear Fail 2013; 1: 156-63.
FEATURED PRODUCTS
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe