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Renal Function, Congestive Heart Failure, and Amino-Terminal Pro-Brain Natriuretic Peptide Measurement

Results From the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study

Saif Anwaruddin, MD^_*, Donald M. Lloyd-Jones, MD, ScM, FACC, Aaron Baggish, MD^_*, Annabel Chen, MD^_*, Daniel Krauser, MD^_*, Roderick Tung, MD^_*, Claudia Chae, MD, MPH, FACC^_* and James L. Januzzi, Jr, MD, FACC^_*,_*

^_* Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

View larger version (18K): [in a new window]   Figure 1 (A) Median amino-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations across categories of renal function for subjects with and without acute congestive heart failure (CHF) in the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study. In addition, (B), the relationship between B-type natriuretic peptide (BNP) concentrations and renal function in the 209 subjects with acute CHF is demonstrated. Boxes denote interquartile ranges, whereas whiskers indicate 5th and 95th percentiles. GFR = glomerular filtration rate.

View larger version (27K): [in a new window]   Figure 2 Relationship between renal function, expressed as glomerular filtration rate (GFR), and amino-terminal pro-brain natriuretic peptide (NT-proBNP) results in the entire ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study cohort of 599 subjects.

View larger version (26K): [in a new window]   Figure 3 Receiver-operating characteristic curves comparing the performance of amino-terminal pro-brain natriuretic peptide for the diagnosis of acute congestive heart failure in breathless subjects with normal-to-mild renal insufficiency (glomerular filtration rate [GFR] 60 ml/min/1.73 m2, n = 393) versus moderate-to-severely impaired renal function (GFR <60 ml/min/1.73 m2, n = 206). The difference between the two curves was not statistically significant (p = 0.34). AUC = area under the curve.

View larger version (30K): [in a new window]   Figure 4 The relationship between median amino-terminal pro-brain natriuretic peptide (NT-proBNP levels), glomerular filtration rate (GFR), and 60-day mortality. Boxes denote interquartile ranges, whereas whiskers indicate 5th and 95th percentiles.