Author + information
- Received June 17, 2015
- Revision received July 9, 2015
- Accepted July 10, 2015
- Published online December 1, 2015.
- Jennifer A. Schaub, MD∗,
- Steven G. Coca, DO, MS†,
- Dennis G. Moledina, MBBS∗,
- Mark Gentry, MA, MLS‡,
- Jeffrey M. Testani, MD, MS∗ and
- Chirag R. Parikh, MD, PhD∗∗ ()
- ∗Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut
- †Ichan School of Medicine at Mount Sinai, New York, New York
- ‡John Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven
- ↵∗Reprint requests and correspondence to:
Dr. Chirag R. Parikh, Section of Nephrology, Yale University School of Medicine, 60 Temple Street, Suite 6C, New Haven, Connecticut 06510.
Objectives This study sought to determine if amino-terminal pro-B-type natriuretic peptide (NT-proBNP) has different diagnostic and prognostic utility in patients with renal dysfunction.
Background Patients with renal dysfunction have higher NT-proBNP, which may complicate interpretation for diagnosis of acute decompensated heart failure (ADHF) or prognosis.
Methods We searched MEDLINE and EMBASE through August 2014 for studies with a subgroup analysis by renal function of the diagnostic or prognostic ability of NT-proBNP.
Results For diagnosis, 9 studies were included with 4,287 patients and 1,325 ADHF events. Patients were mostly divided into subgroups with and without renal dysfunction by an estimated glomerular filtration rate of 60 ml/min/1.73 m2. In patients with renal dysfunction, the area under the curve (AUC) for NT-proBNP ranged from 0.66 to 0.89 with a median cutpoint of 1,980 pg/ml, while the AUC ranged from 0.72 to 0.95 with a cutpoint of 450 pg/ml in patients with preserved renal function. For prognosis, 30 studies with 32,203 patients were included, and mortality in patients with renal dysfunction (25.4%) was twice that of patients with preserved renal function (12.2%). The unadjusted pooled risk ratio for NT-proBNP and mortality was 3.01 (95% confidence interval [CI]: 2.53 to 3.58) in patients with preserved renal function and was similar in patients with renal dysfunction (3.25; 95% CI: 2.45 to 4.30). Upon meta-regression, heterogeneity was partially explained if patients with heart failure or coronary artery disease were enrolled.
Conclusions NT-proBNP retains utility for diagnosis of ADHF in patients with renal dysfunction with higher cutpoints. Elevated NT-proBNP confers a worse prognosis regardless of renal function.
Dr. Schaub is supported by NIH (T32DK007276-36). Dr. Testani is supported by NIH (K23HL114868 and L30HL115790). Dr. Parikh is supported by the NIH (K24DK090203).
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 17, 2015.
- Revision received July 9, 2015.
- Accepted July 10, 2015.
- American College of Cardiology Foundation