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J Am Coll Cardiol, 2006; 47:582-586, doi:10.1016/j.jacc.2005.10.038 (Published online 13 January 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE

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

Takayoshi Tsutamoto, MD*, Atsuyuki Wada, MD, Hiroshi Sakai, MD, Chitose Ishikawa, MD, Toshinari Tanaka, MD, Masaru Hayashi, MD, Masanori Fujii, MD, Takashi Yamamoto, MD, Tomohiro Dohke, MD, Masato Ohnishi, MD, Hiroyuki Takashima, MD, Masahiko Kinoshita, MD and Minoru Horie, MD

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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