This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.08.051v1 47/1/91    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anwaruddin, S. Articles by Januzzi, J. L. Search for Related Content PubMed PubMed Citation Articles by Anwaruddin, S. Articles by Januzzi, J. L., Jr

CLINICAL RESEARCH

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

Manuscript received June 10, 2005; revised manuscript received August 4, 2005, accepted August 9, 2005.

^_* Reprint requests and correspondence: Dr. James L. Januzzi, Jr., Massachusetts General Hospital, Yawkey 5984, 55 Fruit Street, Boston, Massachusetts 02114 (Email: JJanuzzi{at}Partners.org).

OBJECTIVES: We sought to examine the interaction between renal function and amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels.

BACKGROUND: The effects of renal insufficiency on NT-proBNP among patients with and without acute congestive heart failure (CHF) are controversial. We examined the effects of kidney disease on NT-proBNP–based CHF diagnosis and prognosis.

METHODS: A total of 599 dyspneic patients with glomerular filtration rates (GFRs) as low as 14.8 ml/min were analyzed. We used multivariate logistic regression to examine covariates associated with NT-proBNP results and linear regression analysis to analyze associations between NT-proBNP and GFR. Receiver-operating characteristic analysis determined the sensitivity and specificity of NT-proBNP for CHF diagnosis. We also assessed 60-day mortality rates as a function of NT-proBNP concentration.

RESULTS: Glomerular filtration rates ranged from 15 ml/min/1.73 m² to 252 ml/min/1.73m². Renal insufficiency was associated with risk factors for CHF, and patients with renal insufficiency were more likely to have CHF (all p < 0.003). Worse renal function was accompanied by cardiac structural and functional abnormalities on echocardiography. We found that NT-proBNP and GFR were inversely and independently related (p < 0.001) and that NT-proBNP values of > 450 pg/ml for patients ages <50 years and >900 pg/ml for patients 50 years had a sensitivity of 85% and a specificity of 88% for diagnosing acute CHF among subjects with GFR 60 ml/min/1.73 m². Using a cut point of 1,200 pg/ml for subjects with GFR <60 ml/min/1.73 m², we found sensitivity and specificity to be 89% and 72%, respectively. We found that NT-proBNP was the strongest overall independent risk factor for 60-day mortality (hazard ratio 1.57; 95% confidence interval 1.2 to 2.0; p = 0.0004) and remained so even in those with GFR <60 ml/min/1.73 m² (hazard ratio 1.61; 95% confidence interval 1.14 to 2.26; p = 0.006).

CONCLUSIONS: The use of NT-proBNP testing is valuable for the evaluation of the dyspneic patient with suspected CHF, irrespective of renal function.

Abbreviations and Acronyms   BNP = B-type natriuretic peptide   CHF = congestive heart failure   CKD = chronic kidney disease   ED = emergency department   GFR = glomerular filtration rate   IQR = interquartile range   NT-proBNP = amino-terminal pro-brain natriuretic peptide   PRIDE = ProBNP Investigation of Dyspnea in the Emergency Department study   ROC = receiver-operating characteristic