The Relationship Between Nt - ProBNP and Volume Overload in Diabetic Nephropathy Progression

Year 2016, Volume: 43 Issue: 4, 497 - 502, 25.12.2016

Yaşar Yıldırım Zülfükar Yılmaz Müslüm Güneş Ali Veysel Kara Ali Kemal Kadiroğlu Mehmet Emin Yılmaz

Abstract

Objectives: The early diagnosis of volume overload in
chronic kidney disease (CKD) is very important. N-terminal pro-brain
natriuretic peptide (NT-proBNP) is a valuable biomarker for this
purpose. Our study aimed to detect the relationship between NT-proBNP
and left ventricular hypertrophy (LVH), hypertension (HT), GFR, and
proteinuria among diabetic patients with stage 3-4 CKD.

Methods: 160 diabetic patients with stage 3-4 CKD [80
patients in stage 3 CKD (group 1) and 80 patients in stage 4 CKD (group
2)] were enrolled. NT-proBNP levels were evaluated in serum, and
proteinuria was determined from 24-hour collected urine. Left
ventricular hypertrophy was evaluated by M-mode echocardiography.
NT-proBNP levels were compared according to their left ventricular
hypertrophy, hypertension, and proteinuria levels.

Results: NT-proBNP levels was significantly higher,
and GFR was lower in group 2 compared to group1 (p < 0.05). NT-proBNP
was higher in patients with LVH (+) HT (+) and proteinuria ≥ 1gr/d than
patients with LVH (-), HT (-), and proteinuria < 1g/d (p < 0.05).
We found a significant correlation between NT-proBNP levels and left
ventricular posterior wall thickness, diastole (LVPWTd), proteinuria,
SBP, and DBP. Proteinuria was the major contributor to increased
NT-proBNP levels among the independent variables.

Conclusion: We detected that NT-proBNP levels are
increased during the progression of CKD, and proteinuria is the major
cause of increased NT-proBNP levels among the independent variables.

Keywords

NT-proBNP, chronic kidney disease, hypertension, left ventricular hypertrophy

References

• 1. DeFilippi CR, Christenson RH. B-type natriuretic peptide (BNP)/NT-proBNP and renal function: is the controversy over? Clin Chem. 2009 Jul;55:1271-3.
• 2. Cataliotti A, Malatino LS, Jougasaki M, 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 Proc. 2001 Nov;76:1111-9.
• 3. Zoccali C, Mallamaci F, Benedetto FA, et al. Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients. J Am Soc Nephrol. 2001 Jul;12:1508-15.
• 4. Van Kimmenade RR, Januzzi JL Jr, Bakker JA, et al. Renal clearance of B-type natriuretic peptide and amino terminal pro-B-type natriuretic peptide a mechanistic study in hypertensive subjects. J Am Coll Cardiol. 2009 Mar 10;53:884-90.
• 5. Ray P, Delerme S, Jourdain P, Chenevier-Gobeaux C. Differential diagnosis of acute dyspnea: the value of B
• natriuretic peptides in the emergency department. QJM. 2008 Nov;101:831-43.
• 6. 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 Mar;41:571-9.
• 7. Palmer SC, Richards AM. Does renal clearance differ between the B-type natriuretic peptides (BNP versus NT-proBNP)? J Am Coll Cardiol. 2009 Mar 10;53:891-2.
• 8. Srisawasdi P, Vanavanan S, Charoenpanichkit C, Kroll MH. The effect of renal dysfunction on BNP, NT-proBNP, and their
• ratio. Am J Clin Pathol. 2010 Jan;133:14-23.
• 9. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: ev aluation, classification,
• and stratification. Am J Kidney Dis. 2002;39 (2 Suppl 1): S1–266.
• 10. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention,
• Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003 May 21, 289:2560–72.
• 11. Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006 Aug 15;145:247-54.
• 12. Kansal S, Roitman D, Sheffield LT. Interventricular septal thickness and left ventricular hypertrophy. An echocardiographic study. Circulation. 1979 Nov;60:1058-65.
• 13. Kim HN, Januzzi JL Jr. Natriuretic peptide testing in heart failure. Circulation. 2011 May 10;123:2015-9.
• 14. Vickery S, Price CP, John RI, et al. B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with CKD:
• relationship to renal function and left ventricular hypertrophy. Am J Kidney Dis.2005 Oct;46:610-20.
• 15. DeFilippi CR, Fink JC, Nass CM, et al. N-terminal pro-B-type natriuretic peptide for predicting coronary disease and left ventricular hypertrophy in asymptomatic CKD not requiring dialysis. Am J Kidney Dis. 2005 Jul;46:35-44.
• 16. Khan IA, Fink J, Nass C, et al. N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide for
• identifying coronary artery disease and left ventricular hypertrophy in ambulatory chronic kidney disease patients. Am
• J Cardiol. 2006 May 15;97:1530-4.
• 17. 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 Sep;44:420-8.
• 18. Anwaruddin S, Lloyd-Jones DM, Baggish A, et al. Renal function, conges tive heart failure, and aminoterminal probrain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency
• Department (PRIDE) Study. J Am Coll Cardiol. 2006 Jan 3;47:91-7.
• 19. Spanaus KS, Kronenberg F, Ritz E, et al. B-type natriuretic peptide concentrations predict the progression of nondiabetic
• chronic kidney disease: the Mildto Moderate Kidney Disease Study. Clin Chem. 2007 Jul;53:1264-72.
• 20. Tagore R, Ling LH, Yang H, et al. Natriuretic peptides in chronic kidney disease. Clin J Am Soc Nephrol. 2008 Nov;3:1644-51.
• 21. Martinez Rumayor A, Richards AM, Burnett JC, Januzzi JL Jr. Biology of the natriuretic peptides. Am J Cardiol 2008 Feb 4;101(3A):3-8.
• 22. Khalifeh N, Haider D, Horl WH. Natriuretic peptides in chronic kidney disease and during renal replacement herapy:
• An update. J Investig Med. 2009 Jan; 57:33-39.
• 23. Foley RN, Parfrey PS, Kent GM, et al. Longterm evolution of cardiomyopathy in dialysis patients. Kidney Int. 1998 Nov;54:1720-5.