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Effect of renal failure on N-terminal Pro-Brain natriuretic peptide in patients admitted to emergency department with acute dyspnea.

AbstractOBJECTIVE:
Preexisting renal failure diminishes the excretion of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), therefore limits the diagnostic value of this peptide for concomitant heart failure. The aim of this study was to evaluate the association between NT-proBNP and the stages of renal dysfunction in a typical population attended to emergency department with acute dyspnea.
METHODS:
In this cross-sectional study, all consecutive patients with acute dyspnea underwent clinical evaluation, laboratory assessment of NT-proBNP, and echocardiographic examinations. Among subjects, 54.5% were diagnosed as heart failure. Grouping variables according to renal function capacity and ejection fraction, independent variables were compared with Kruskal-Wallis or ANOVA with posthoc tests. Correlation and linear regression analysis were done to analyze the variables associated with NT-proBNP. The diagnostic performance of NT-proBNP was evaluated by receiver-operating characteristic (ROC) curve.
RESULTS:
Serum median NT-proBNP level in patients with severe renal impairment was significantly higher than moderate and mildly decreased renal functions (p=0.001). In patients with moderate and severe left ventricular failure, NT-proBNP was significantly higher compared with normal subjects (LVEF>50%) (p=0.040, and 0.017, respectively). Renal dysfunction was associated in 56% of patients with heart failure. The area under the ROC curve of NT-proBNP for identifying left ventricular failure in patients with renal failure (eGFR<90 mL/min/1.73 m2) was 0.649 and reached significant difference (95% CI:0.548-0.749, p=0.005).
CONCLUSION:
In addition to NT-proBNP measurement in clinical judgement of heart failure, renal functions have to be taken into consideration to avoid misdiagnosis.
AuthorsAyfer Çolak, Serap Çuhadar, Burcu Gölcük, Yalçin Gölcük, Öner Özdoğan, Işil Çoker
JournalAnadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology (Anadolu Kardiyol Derg) Vol. 14 Issue 6 Pg. 519-24 (Sep 2014) ISSN: 1308-0032 [Electronic] Turkey
PMID25233498 (Publication Type: Evaluation Study, Journal Article)
Chemical References
  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
Topics
  • Biomarkers (blood)
  • Cross-Sectional Studies
  • Dyspnea (etiology)
  • Echocardiography
  • Emergency Service, Hospital
  • Female
  • Heart Failure (blood, complications, diagnosis, diagnostic imaging)
  • Humans
  • Male
  • Natriuretic Peptide, Brain (blood)
  • Patient Admission
  • Peptide Fragments (blood)
  • Predictive Value of Tests
  • ROC Curve
  • Renal Insufficiency (blood, complications)

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