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Efficacy of N-terminal pro-brain natriuretic peptide digit number for screening of cardiac disease in new haemodialysis patients.

AbstractAIM:
The usefulness of the absolute N-terminal pro-brain natriuretic peptide (NT-ProBNP) concentration and its digit number for screening for cardiac disease was explored in new haemodialysis patients.
METHODS:
A cross-sectional study involving 71 (68 ± 14 years, 83% male) new dialysis patients was conducted. Receiver operator characteristic curve analysis was performed to identify the cutoff level of NT-proBNP for identifying cardiac disease at the start of dialysis.
RESULTS:
The median NT-proBNP concentration was 6576 pg/mL just before the first dialysis session and its mean digit number was 4.3 ± 0.6. Overall, 67%, 52%, 9% and 35% of patients had left ventricular (LV) hypertrophy, LV dilatation, systolic dysfunction and significant coronary artery disease, respectively. NT-proBNP levels of about 6000, 10,000 and 14,000 pg/mL were the best cutoff levels for the diagnosis of coronary artery disease (AUC, 0.754; P < 0.001), LV systolic dysfunction (area under the curve (AUC), 0.765, P = 0.001) and LV dilatation (AUC, 0.685, P = 0.008), respectively. Interestingly, 4.5 was the best digit number cutoff for all cardiac abnormalities. These findings suggest that a digit number of 5 or more means a potentially high risk for cardiovascular disease and a digit number of 3 or less means a relatively low risk.
CONCLUSIONS:
The NT-proBNP concentration just before the first dialysis session is a useful tool for screening for cardiac abnormalities. Considering the wide variation of the NT-proBNP cutoff levels depending on each cardiac abnormality, the digit number could be potentially easier to use for initial risk stratification for cardiac disease in new dialysis patients.
AuthorsMasaki Iwasaki, Nobuhiko Joki, Yuri Tanaka, Nobutaka Ikeda, Toshihide Hayashi, Shun Kubo, Takasuke Asakawa, Yasunori Takahashi, Koichi Hirahata, Yoshihiko Imamura, Hiroki Hase
JournalNephrology (Carlton, Vic.) (Nephrology (Carlton)) Vol. 18 Issue 7 Pg. 497-504 (Jul 2013) ISSN: 1440-1797 [Electronic] Australia
PMID23574011 (Publication Type: Evaluation Study, Journal Article)
Copyright© 2013 The Authors. Nephrology © 2013 Asian Pacific Society of Nephrology.
Chemical References
  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
Topics
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Biomarkers (blood)
  • Coronary Artery Disease (blood, diagnosis)
  • Cross-Sectional Studies
  • Female
  • Heart Diseases (blood, diagnosis, epidemiology)
  • Humans
  • Hypertrophy, Left Ventricular (blood, diagnosis)
  • Japan (epidemiology)
  • Kidney Failure, Chronic (diagnosis, epidemiology, therapy)
  • Linear Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Natriuretic Peptide, Brain (blood)
  • Peptide Fragments (blood)
  • Predictive Value of Tests
  • Prevalence
  • ROC Curve
  • Renal Dialysis
  • Risk Assessment
  • Risk Factors
  • Up-Regulation
  • Ventricular Dysfunction, Left (blood, diagnosis)

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