DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20211882

Brain natriuretic peptide in differentiating cardiogenic and non- cardiogenic dyspnoea in patients with renal dysfunction: a single centre study

Sruthi Meenaxshi Subbiah Renganathan, Madhukar Rai, Tiwari J. P., Tej Bali Singh

Abstract


Background: Both BNP (Brain Natriuretic Peptide) and renal function are prognostic indicators of survival in patients with congestive heart failure. However, relationship between BNP, renal function and heart failure as an emergency diagnosis are unknown. The usefulness of BNP as a diagnostic tool in patients with renal dysfunction is thus explored in this study.

Methods: The present study was prospectively designed diagnostic test evaluation study conducted in Banaras Hindu University, Varanasi. Out of 166 participants with renal dysfunction defined as creatinine >1.5mg/dl who presented with acute dyspnoea, clinical history, BNP, 2D Echo and baseline estimated glomerular filtration rate were assessed. Patients with severe anaemia, eGFR less than 15 ml/min/1.73 m2 and those on dialysis therapy were excluded from the study. The final diagnosis was adjudicated by cardiologist who was blinded to BNP values.

Results: The final diagnosis of CHF was in 104 (62.7%). The correlation between BNP and eGFR values were r=-0.49 for those with CHF (p<0.001) and r=-0.279 (p<0.028) for those without CHF. Median BNP in patients with renal dysfunction with CHF was 1206 pg/ml and without CHF was 186 pg/ml. The area under the receiver operating characteristic curve and optimal cutpoints for EGFR categories 59-30 ml /min/1.73 m2 and EGFR less than 30 ml/min/1.73m2 were 0.992 and 491.5 pg/ml (sensitivity 97% and specificity 95%) and 1.000 and 512pg/ml (sensitivity 100% and specificity  95.5%) respectively.

Conclusions: Renal function weakly correlates with BNP in patients without CHF (congestive heart failure). BNP is an important bed side tool for distinguishing cardiogenic and non-cardiogenic dyspnoea in patients with renal dysfunction requiring higher diagnostic cut points. Thus the present study emphasises BNP is the strong and independent predictor of CHF even after taking renal function into considerations.

 

Keywords


Brain natriuretic peptide, Renal dysfunction, Congestive heart failure

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References


Takase H. Brain natriuretic peptide detects cardiac abnormalities in mass screening, Eur J Clin Invest. 2007;37(4):257-62.

Goto T, Takase H, Toriyama T. Increased circulating levels of natriuretic peptides predict future cardiac event in patients with chronic hemodialysis. Nephron. 2002;92:610-5.

Mukoyama M. Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest. 1992;87(4):1402-12.

McCullough PA, Duc P, Omland T. 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.

Cataliotti A, Malatino LS, Jougasaki M. Circulating natriuretic peptide concentrations in patients with end-stage renal disease: role of brain natriuretic peptide as a biomarker for ventricular remodeling. Mayo Clin Proc. 2001;76:1111-9.

Mueller C. B-type natriuretic peptide for acute dyspnea in patients with kidney disease: Insights from a randomized comparison. Kidney Int. 2005;67(1):278-84.

Mueller C, Laule KK, Scholer A. B-type natriuretic peptide for acute dyspnea in patients with kidney disease: insights from a randomized comparison. Kidney Int. 2005;67:278-84.

Mueller C, Scholer A, Laule KK. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med. 2004;350:647-54.

Takami Y, Horio T, Iwashima Y. Diagnostic and prognostic value of plasma brain natriuretic peptide in non-dialysis-dependent CRF. Am J Kidney Dis. 2004;44:420-8.

Maisel AS, Krishnaswamy P, Nowak RM. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347:161-7.

Alan M, McCord J, Nowak RM. 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.

Anwaruddin S, Jones D, Baggish A, Chen A, Krauser D, Tung R, et al. Renal function, congestive heart failure, and amino-terminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study. J Am College Cardiol. 2006;47:91-7.

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2):261-6.

Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010;55(4):622-7.

Levey AS, Coresh J, Balk E. National Kidney Foundation Practice Guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139:137-47.

Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.

Froissart M, Rossert J, Jacquot C. Predictive performance of the modification of diet in renal disease and cockcroft-gault equations for estimating renal function. J Am Soc Nephrol. 2005;16:763-73.

Baxter GF. The natriuretic peptides. Basic Res Cardiol. 2004;99:71-5.

Schmitt BP, Kushner MS, Wiener SL. The diagnostic usefulness of the history of the patient with dyspnea. J Gen Intern Med. 1986;1(6):386-93.

Hirata Y. Measurement of plasma brain natriuretic peptide level as a guide for cardiac overload. Cardiovasc Res. 2001;51(3):585-91.

Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. 3rd ed. Boston: Butterworths, 1990.

Sagnella GA. Measurement and significance of circulating natriuretic peptides in cardiovascular disease. Clin Sci. 1998;95:519-29.

Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet. 2004;364:613-20.

Rees J. ABC of asthma prevalence. BMJ. 2005;331(7514):443-5.

Wang CS, Gerald JM, Schulzer M. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294:1944-56.

Teboul A, Gaynel A, Meune C, Grevet A, Sauval P, Carli P. Management of acute dyspnea: Use and feasibility of brain natriuretic peptide (BNP) assay in the prehospital setting. resuscitation. 2004;61:91-6.

Galvani M, Ferrini D, Ottani F. Natriuretic peptides for risk stratification of patients with acute coronary syndromes. Eur J Heart Fail. 2004;6:327-33.

Mallamaci F, Zoccali C, Tripepi G. Diagnostic potential of cardiac natriuretic peptides in dialysis patients. Kidney Int. 2001;59:1559-66.

Manning HL, Schwartzstein RM. Pathophysiology of dyspnea. N Engl J Med. 1995;333:1547-53.

Milzman DP, Barbaccia J, Davis G. ED presentation of dyspnea in HF patients results in increased hospital stay and medication costs. Ann Emerg Med. 2005;46:38-9.

Spanaus KS. B-type natriuretic peptide concentrations predict the progression of nondiabetic chronic kidney disease: the mild-to-moderate kidney disease study. Clin Chem. 2007;53(7):1264-72.

Knudsen CW, Omland T, Clopton P. Impact of atrial fibrillation on the diagnostic performance of B-type natriuretic peptide concentration in dyspneic patients: an analysis from the breathing not properly multinational study. J Am Coll Cardiol. 2005;46:838-44.

Koglin J, Pehlivanli S, Schwaiblmair M, Vogeser M, Cremer P, Scheidt W. Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure. J Am Coll Cardiol. 2001;38:1934-41.

Lang CC, Choy AM, Henderson IS, et al. Effect of haemodialysis on plasma levels of brain natriuretic peptide in patients with chronic renal failure. Clin Sci (Lond). 1992;82:127-31

Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC. “Plasma brain natriuretic peptide concentration: impact of age and gender,” J. Am. Coll. Cardiol. 2002;40(5):976-82.

Kawai K. “Attenuation of biologic compensatory action of cardiac natriuretic peptide system with aging,” Am. J. Cardiol. 2004;93(6)719-23.

Maisel A, Doyle J, Schwam E. 'B-type natriuretic peptide in the emergency department: A valuable diagnostic aid (1) (multiple letters).' academic emergency Med. 2005;12:572-4.

Maisel AS, Koon J, Krishnaswamy P, et al. Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am Heart J. 2001;141:367-74.

McCullough PA, Nowak RM, McCord J. B‐type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) multinational study. Circulation. 2002;106:416-22.

McCullough PA, Duc P, Omland T. 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.