Circulating natriuretic peptide concentrations in patients with end-stage renal disease: Role of brain natriuretic peptide as a biomarker for ventricular remodeling
A. Cataliotti et al., Circulating natriuretic peptide concentrations in patients with end-stage renal disease: Role of brain natriuretic peptide as a biomarker for ventricular remodeling, MAYO CLIN P, 76(11), 2001, pp. 1111-1119
Citations number
30
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Objectives: To determine levels of natriuretic peptides (NPs) in patients w
ith end-stage renal disease (ESRD) and to examine the relationship of these
cardiovascular peptides to left ventricular hypertrophy (LVH) and to cardi
ac mortality. Patients and Methods: One hundred twelve dialysis patients wi
thout clinical evidence of congestive heart failure underwent plasma measur
ement of NP concentrations and echocardiographic investigation for left ven
tricular mass index (LVMI). Results: Plasma atrial natriuretic peptide (ANP
) and brain natriuretic peptide (BNP) concentrations correlated positively
with LVMI and inversely with left ventricular ejection fraction, whereas C-
type NP and Dendroaspis NP levels did not correlate with LVMI. In dialysis
patients with LVH (LVMI > 125 g/m(2)), plasma ANP and BNP concentrations we
re increased compared with those in dialysis patients without LVH (both P <
.001). In a subset of 15 dialysis patients without LVH or other concomitan
t diseases, plasma BNP concentrations were not significantly increased comp
ared with those in 35 controls (mean +/- SDI 20.1 +/- 13.4 vs 13.5 +/-9.6 p
g/mL; P=.06), demonstrating that the BNP concentration was not increased by
renal dysfunction alone. Furthermore, the BNP level was significantly high
er in the 16 patients who died from cardiovascular causes compared with sur
vivors (mean SD, 129 +/- 13 vs 57 +/-7 pg/mL; P < 003) and was significantl
y associated with greater risk of cardiovascular death in Cox regression an
alysis (P < 001), as was the ANP level (P=.002). Conclusions: Elevation of
the plasma BNP concentration is more specifically related to LVH compared w
ith the other NP levels in patients with ESRD independent of congestive hea
rt failure. Thus, BNP serves as an important plasma biomarker for ventricul
ar hypertrophy in dialysis patients with ESRD.