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Raised plasma N-terminal pro-B-type natriuretic peptide concentrations predict mortality and cardiac disease in end-stage renal disease
  1. R Sharma1,
  2. D C Gaze2,
  3. D Pellerin3,
  4. R L Mehta4,
  5. H Gregson5,
  6. C P Streather5,
  7. P O Collinson2,
  8. S J D Brecker1
  1. 1Department of Cardiology, St George’s Hospital, London, UK
  2. 2Department of Chemical Pathology, St George’s Hospital, London, UK
  3. 3The Heart Hospital, London, UK
  4. 4Department of Medical Statistics, Southampton University Hospital, Southampton, UK
  5. 5Department of Renal Medicine, St George’s Hospital, London, UK
  1. Correspondence to:
    Dr Rajan Sharma
    Department of Cardiology, Southampton University Hospital, Tremona Road, Southampton SO16 6YD, UK; rajdoc.Sharma{at}tiscali.co.uk

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N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations are raised in a proportion of patients with heart failure and acute coronary syndrome and provide diagnostic and prognostic information. Inclusion cut-off values vary according to age, sex and estimated glomerular filtration rate (eGFR).1,2 Raised NT-proBNP concentrations are found in a proportion of patients with end-stage renal disease (ESRD). The significance and reasons for this remain uncertain.

The objective of this study was to investigate whether NT-proBNP predicts mortality in a group of patients with ESRD. The secondary end point was to examine differences in patients with and without raised NT-proBNP, according to the cut-off value that best predicted mortality.

METHODS

One hundred and forty renal transplant candidates were prospectively studied. Long-term survival status was obtained in all patients. The study was approved by the local ethics committee. All participants gave written informed consent.

All patients had baseline transthoracic echocardiography, dobutamine stress echocardiography (DSE) and coronary angiography. The protocol for these was previously described.3 A positive DSE response was described by the occurrence under stress of hypokinesia, akinesia or dyskinesia in one or more resting normal segments or worsening of wall motion in one or more resting hypokinetic segments. Significant coronary artery disease (CAD) was defined as luminal stenosis > 70% in one or more epicardial artery.

Whole blood venous samples were collected at the time of DSE before infusion of dobutamine. Cardiac troponin T …

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