B-type natriuretic peptide and renal function in the diagnosis of heart failure: An analysis from the breathing not properly multinational study

doi:10.1053/ajkd.2003.50118

American Journal of Kidney Diseases

Volume 41, Issue 3, March 2003, Pages 571-579

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https://doi.org/10.1053/ajkd.2003.50118 Get rights and content

Abstract

Background: Both B-type natriuretic peptide (BNP) and renal function are prognostic indicators of survival in patients with congestive heart failure (CHF). However, relationships between BNP, renal function, and heart failure as an emergency diagnosis are unknown. Methods: The Breathing Not Properly Multinational Study was a prospectively designed diagnostic test evaluation study conducted in seven centers. Of 1,586 participants who presented with acute dyspnea, 1,452 patients (91.6%) had both BNP level and baseline estimated glomerular filtration rate (eGFR) available. Patients with an eGFR less than 15 mL/min/1.73 m² and those on dialysis therapy were excluded. The final diagnosis was adjudicated by two independent cardiologists who were blinded to BNP results. Results: The final diagnosis was CHF in 715 patients (49.2%). Raw and log-log transformed correlations between BNP and eGFR values were r = −0.19 and r = −0.17 for those with CHF and r = −0.20 and r = −0.31 for those without CHF (both P < 0.0001 for r ≠ 0). Mean BNP levels were 561.6 pg/mL (162.3 fmol/mL), 647.5 pg/mL (187.1 fmol/mL), 745.6 pg/mL (215.5 fmol/mL), and 850.7 pg/mL (245.8 fmol/mL) for those with CHF and 85.4 pg/mL (24.7 fmol/mL), 131.7 pg/mL (38.1 fmol/mL), 297.2 pg/mL (85.9 fmol/mL), and 285.0 pg/mL (82.3 fmol/mL) for those without CHF in eGFR categories of 90 or greater, 89 to 60, 59 to 30, and less than 30 mL/min/1.73 m², respectively. The area under the receiver operating characteristic curve and optimum cut points for BNP were 0.91 and 70.7 pg/mL (20.4 fmol/mL), 0.90 and 104.3 pg/mL (30.1 fmol/mL), 0.81 and 201.2 pg/mL (58.1 fmol/mL), and 0.86 and 225.0 pg/mL (65.0 fmol/mL) for the eGFR categories of 90 or greater, 89 to 60, 59 to 30, and less than 30 mL/min/1.73 m², respectively. Conclusion: Renal function correlates weakly with BNP and influences the optimal cut point for BNP, particularly in those with an eGFR less than 60 mL/min/1.73 m². Am J Kidney Dis 41:571-579. © 2003 by the National Kidney Foundation, Inc.

Section snippets

Setting

The Breathing Not Properly Multicenter Study was an international, seven-center, prospective study (five US centers and two European centers). Study design and main results of the Breathing Not Properly Multinational Study have been published elsewhere.¹³ Study investigators and centers are listed in the Appendix. The study was conducted from April 1999 to December 2000. The study protocol was approved by the institutional review boards of all study centers, and written informed consent was

Baseline characteristics

Demographics for the study sample were as follows: age, 64.8 ± 16.1 years; range, 18 to 105 years; 814 men (56.1%), 638 women (43.9%); 724 Caucasians (49.9%), 639 African Americans (44.0%), and 98 other races (6.1%). These baseline demographics did not differ from the entire Breathing Not Properly Study cohort previously reported.¹³ Risk factors for CHF or CKD included history of hypertension in 821 patients (56.5%), diabetes in 345 patients (21.8%), previous CHF in 507 patients (34.9%), and

Discussion

This is the first large-scale prospective study of BNP as a diagnostic test allowing evaluation of the independent relationships between renal function, BNP, and CHF as a final diagnosis. Results of this study build on the main results of the pivotal Breathing Not Properly Multinational Study in establishing correlations between eGFR and BNP level in patients with and without CHF.¹³ Relationships in terms of correlation coefficients can be considered weak, but statistically significant. We have

Acknowledgements

The authors thank the ED staff at the following Breathing Not Properly Multinational Study Centers: San Diego Veteran's Affairs Medical Center, San Diego, CA; Henry Ford Hospital, Detroit, MI; Hospital of the University of Pennsylvania, Philadelphia, PA; Hospital Bichat, Paris, France; Ullevål University Hospital, Oslo, Norway; University of Cincinnati Medical Center, Cincinnati, OH; and Hartford Hospital, Hartford, CT.

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^*: For the Breathing Not Properly Multinational Study Investigators (see Appendix for study information).

^**: Triage BNP devices and meters and some financial support was provided by Biosite Inc, San Diego, CA. A.S.M., P.A.M., P.C., R.M.N., J.M., J.E.H., P.D., T.O., A.B.S., W.T.A., A.H.B.W., and R.K. have received honoraria from the manufacturer of the BNP assay used in the study.

^*: Address reprint requests to Peter A. McCullough, MD, Divisions of Cardiology, Nutritional and Preventive Medicine, William Beaumont Hospital, Beaumont Health Center, 4949 Coolidge, Royal Oak, MI 48073. E-mail: [email protected]

^**: 0272-6386/03/4103-0005$30.00/0

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Original Investigations: Pathogenesis and Treatment of Kidney Disease and HypertensionB-type natriuretic peptide and renal function in the diagnosis of heart failure: An analysis from the breathing not properly multinational study*,**,*,**

Abstract

Section snippets

Setting

Baseline characteristics

Discussion

Acknowledgements

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Ann Emerg Med

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Mayo Clin Proc

Am Heart J

Biochem Biophys Res Commun

Biochem Biophys Res Commun

Eur J Pharmacol

Regul Pept

US Department of Health and Human Services, Detailed Diagnoses and Procedures, National Hospital Discharge Survey, 1990

An epidemic of heart failure? Recent evidence from Europe

Eur Heart J

Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension
B-type natriuretic peptide and renal function in the diagnosis of heart failure: An analysis from the breathing not properly multinational study*,**,*,**