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CLINICAL RESEARCH: HEART FAILURE

Relationship Between Renal Function and Plasma Brain Natriuretic Peptide in Patients With Heart Failure

Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan

Manuscript received June 5, 2005; revised manuscript received October 5, 2005, accepted October 10, 2005.

^_* Reprint requests and correspondence: Dr. Takayoshi Tsutamoto, Cardiovascular and Respiratory Medicine, Shiga University of Medical Science Tsukinowa, Seta, Otsu 520-2192, Japan (Email: tutamoto{at}belle.shiga-med.ac.jp).

OBJECTIVES: This study sought to evaluate the relationship between brain natriuretic peptide (BNP), renal function, and the severity of congestive heart failure (CHF).

BACKGROUND: Both BNP and renal function are prognostic predictors in CHF patients.

METHODS: We measured the plasma BNP level in the aortic root and coronary sinus in 366 consecutive patients with CHF. Estimated glomerular filtration rate (eGFR) by the Cockcroft-Gault equation was used as an indicator of renal function.

RESULTS: By stepwise multivariate analyses, hemodynamic parameters such as left ventricular ejection fraction (LVEF) and left ventricular end-diastolic pressure (LVEDP) but not eGFR were independent predictors of a transcardiac increase (coronary sinus-aortic root) in BNP. Regarding the plasma level of BNP in the aortic root, not only LVEF (p < 0.0001) and LVEDP (p < 0.0001) but also eGFR (p < 0.0001) were independent predictors. Patients were divided into two groups, patients with an eGFR 60 ml/min (group 1, n = 229) and patients with an eGFR <60 ml/min (group 2, n = 137). There was no difference in LVEF, LVEDP, or the transcardiac gradient of BNP between the two groups, but the plasma level of BNP in the aortic root was approximately two-fold greater in group 2 than in the group 1.

CONCLUSIONS: These findings suggest that decreased clearance from the kidney contributes to the elevated BNP in CHF patients with renal dysfunction, especially in patients with an eGFR <60 ml/min.

Abbreviations and Acronyms   BNP = brain natriuretic peptide   CHF = congestive heart failure   CKD = chronic kidney disease   eGFR = estimated glomerular filtration rate   GFR = glomerular filtration rate   LVEDP = left ventricular end-diastolic pressure   LVEF = left ventricular ejection fraction

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