BNP Did Not Predict Cardiac Events in Acute Dyspneic Patients With Severe Chronic Kidney Disease

Abstract

Renal dysfunction has been shown to affect BNP levels and the diagnostic or prognostic value of BNP levels in the presence of renal insufficiency (RI) has been questioned. The aim of this study was to evaluate the impact of RI on diagnostic and prognostic value of B-type natriuretic peptide (BNP) in patients with acute congestive heart failure (CHF). Of 1,207 participants who presented with acute dyspnea, we excluded patients with chronic or acute pulmonary lung disease, liver cirrhosis, significant anemia (Hb< 10g/dl), estimated glomerular filtration rate (eGFR) < 15 ml/min/1.73m2 or those on dialysis. 549 patients with acute dyspnea were included and divided 3 groups according to the level of eGFR. The final diagnosis was CHF in 479 (87.2%) patients. According to the severity of RI, the diagnostic accuracy of BNP was as follow: normal to mild; 0.932 at 156.5, moderate; 0.952 at 182.0, severe; 0.949 at 243.0 pg/ml of BNP (p<0.001). By multivariate Cox proportional hazards analysis, hypertension and severe renal insufficiency were powerful independent predictors of cardiac event. Renal function affected to BNP level for diagnosis of CHF and predicting of mortality in acute heart failure. But BNP did not predict cardiac events in acute dyspneic patients with chronic kidney disease.