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Association of N-terminal pro-B-type natriuretic peptide with contrast-induced nephropathy and long-term outcomes in patients with chronic kidney disease and relative preserved left ventricular function.

Liu YH, Liu Y, Zhou YL, Yu DQ, He PC, Xie NJ, Li HL - Medicine (Baltimore) (2015)

Bottom Line: Univariate logistic analysis showed that lg-NT-pro-BNP was significantly associated with CIN (odds ratio [OR] = 3.93, 95% confidence interval [CI], 2.22-6.97, P < 0.001).Furthermore, lg-NT-pro-BNP remained a significant predictor of CIN (OR = 3.30, 95% CI, 1.57-6.93, P = 0.002), even after adjusting for potential confounding risk factors.These results were confirmed by using other CIN criteria, which were defined as elevations of the SCr by 25% or 0.5 and 0.3 mg/dL from the baseline.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology (Y-hL, YL, Y-lZ, D-qY, P-cH, N-JX, H-lL, W-G, J-yC, NT), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; and Southern Medical University (Y-hL), Guangzhou, Guangdong, China.

ABSTRACT
The aim of the present article was to evaluate the association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) with contrast-induced nephropathy (CIN) and long-term outcomes in patients with chronic kidney disease (CKD) and relative preserved left ventricular function (LVF) undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 1203 consecutive patients with CKD and preserved LVF undergoing elective PCI. The primary end point was the development of CIN, defined as an absolute increase in serum creatinine (SCr) ≥0.5 mg/dL, from baseline within 48 to 72 hours after contrast medium exposure. CIN incidence varied from 2.2% to 5.2%. Univariate logistic analysis showed that lg-NT-pro-BNP was significantly associated with CIN (odds ratio [OR] = 3.93, 95% confidence interval [CI], 2.22-6.97, P < 0.001). Furthermore, lg-NT-pro-BNP remained a significant predictor of CIN (OR = 3.30, 95% CI, 1.57-6.93, P = 0.002), even after adjusting for potential confounding risk factors. These results were confirmed by using other CIN criteria, which were defined as elevations of the SCr by 25% or 0.5 and 0.3 mg/dL from the baseline. The best cutoff value of lg-NT-pro-BNP for detecting CIN was 2.73 pg/mL (537 pg/mL) with 73.1% sensitivity and 70.0% specificity according to the receiver operating characteristic (ROC) analysis (C statistic = 0.754, 95% CI, 0.67-0.84, P < 0.001). In addition, NT-pro-BNP ≥537 pg/mL (2.73 pg/mL, lg-NT-pro-BNP) was associated with an increased risk of all-cause mortality and composite end points during 2.5 years of follow-up. NT-pro-BNP ≥537 pg/mL is independently associated with an increased risk of CIN with different definitions and poor clinical outcomes in patients with CKD and relative preserved LVF undergoing PCI.

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Cumulative rate of all-cause mortality between patients with lg-NT-pro-BNP levels ≥2.73 or <2.73 pg/mL, and among subgroups with eGFR ≤60 mL/min/1.73 m2 or 60 < eGFR ≤ 90 mL/min/1.73 m2. eGFR = estimated glomerular filtration rate, NT-pro-BNP = N-terminal pro-B-type natriuretic peptide.
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Figure 4: Cumulative rate of all-cause mortality between patients with lg-NT-pro-BNP levels ≥2.73 or <2.73 pg/mL, and among subgroups with eGFR ≤60 mL/min/1.73 m2 or 60 < eGFR ≤ 90 mL/min/1.73 m2. eGFR = estimated glomerular filtration rate, NT-pro-BNP = N-terminal pro-B-type natriuretic peptide.

Mentions: Based on the Kaplan–Meier analysis, clinical outcomes, including all-cause mortality and composite end points, were significantly worse in patients with lg-NT-pro-BNP ≥2.73 pg/mL compared with those in patients with lg-NT-pro-BNP <2.73 pg/mL (both P < 0.001) (Figure 3). For patients with 60 < eGFR ≤ 90 mL/min/1.73 m2, outcome was significantly worse in patients with lg-NT-pro-BNP ≥2.73 pg/mL compared with that in patients with lg-NT-pro-BNP <2.73 pg/mL (cumulative rate of mortality 3.3% vs 1.2%, P = 0.029; Figure 4). For patients with eGFR ≤60 mL/min/1.73 m2, Kaplan–Meier analysis also indicated a significantly worse prognosis in subjects with lg-NT-pro-BNP ≥2.73 pg/mL compared with that in patients with lg-NT-pro-BNP <2.73 pg/mL (cumulative rate of mortality 13.6% vs 3.4%, P = 0.029; Figure 4).


Association of N-terminal pro-B-type natriuretic peptide with contrast-induced nephropathy and long-term outcomes in patients with chronic kidney disease and relative preserved left ventricular function.

Liu YH, Liu Y, Zhou YL, Yu DQ, He PC, Xie NJ, Li HL - Medicine (Baltimore) (2015)

Cumulative rate of all-cause mortality between patients with lg-NT-pro-BNP levels ≥2.73 or <2.73 pg/mL, and among subgroups with eGFR ≤60 mL/min/1.73 m2 or 60 < eGFR ≤ 90 mL/min/1.73 m2. eGFR = estimated glomerular filtration rate, NT-pro-BNP = N-terminal pro-B-type natriuretic peptide.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554022&req=5

Figure 4: Cumulative rate of all-cause mortality between patients with lg-NT-pro-BNP levels ≥2.73 or <2.73 pg/mL, and among subgroups with eGFR ≤60 mL/min/1.73 m2 or 60 < eGFR ≤ 90 mL/min/1.73 m2. eGFR = estimated glomerular filtration rate, NT-pro-BNP = N-terminal pro-B-type natriuretic peptide.
Mentions: Based on the Kaplan–Meier analysis, clinical outcomes, including all-cause mortality and composite end points, were significantly worse in patients with lg-NT-pro-BNP ≥2.73 pg/mL compared with those in patients with lg-NT-pro-BNP <2.73 pg/mL (both P < 0.001) (Figure 3). For patients with 60 < eGFR ≤ 90 mL/min/1.73 m2, outcome was significantly worse in patients with lg-NT-pro-BNP ≥2.73 pg/mL compared with that in patients with lg-NT-pro-BNP <2.73 pg/mL (cumulative rate of mortality 3.3% vs 1.2%, P = 0.029; Figure 4). For patients with eGFR ≤60 mL/min/1.73 m2, Kaplan–Meier analysis also indicated a significantly worse prognosis in subjects with lg-NT-pro-BNP ≥2.73 pg/mL compared with that in patients with lg-NT-pro-BNP <2.73 pg/mL (cumulative rate of mortality 13.6% vs 3.4%, P = 0.029; Figure 4).

Bottom Line: Univariate logistic analysis showed that lg-NT-pro-BNP was significantly associated with CIN (odds ratio [OR] = 3.93, 95% confidence interval [CI], 2.22-6.97, P < 0.001).Furthermore, lg-NT-pro-BNP remained a significant predictor of CIN (OR = 3.30, 95% CI, 1.57-6.93, P = 0.002), even after adjusting for potential confounding risk factors.These results were confirmed by using other CIN criteria, which were defined as elevations of the SCr by 25% or 0.5 and 0.3 mg/dL from the baseline.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology (Y-hL, YL, Y-lZ, D-qY, P-cH, N-JX, H-lL, W-G, J-yC, NT), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; and Southern Medical University (Y-hL), Guangzhou, Guangdong, China.

ABSTRACT
The aim of the present article was to evaluate the association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) with contrast-induced nephropathy (CIN) and long-term outcomes in patients with chronic kidney disease (CKD) and relative preserved left ventricular function (LVF) undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 1203 consecutive patients with CKD and preserved LVF undergoing elective PCI. The primary end point was the development of CIN, defined as an absolute increase in serum creatinine (SCr) ≥0.5 mg/dL, from baseline within 48 to 72 hours after contrast medium exposure. CIN incidence varied from 2.2% to 5.2%. Univariate logistic analysis showed that lg-NT-pro-BNP was significantly associated with CIN (odds ratio [OR] = 3.93, 95% confidence interval [CI], 2.22-6.97, P < 0.001). Furthermore, lg-NT-pro-BNP remained a significant predictor of CIN (OR = 3.30, 95% CI, 1.57-6.93, P = 0.002), even after adjusting for potential confounding risk factors. These results were confirmed by using other CIN criteria, which were defined as elevations of the SCr by 25% or 0.5 and 0.3 mg/dL from the baseline. The best cutoff value of lg-NT-pro-BNP for detecting CIN was 2.73 pg/mL (537 pg/mL) with 73.1% sensitivity and 70.0% specificity according to the receiver operating characteristic (ROC) analysis (C statistic = 0.754, 95% CI, 0.67-0.84, P < 0.001). In addition, NT-pro-BNP ≥537 pg/mL (2.73 pg/mL, lg-NT-pro-BNP) was associated with an increased risk of all-cause mortality and composite end points during 2.5 years of follow-up. NT-pro-BNP ≥537 pg/mL is independently associated with an increased risk of CIN with different definitions and poor clinical outcomes in patients with CKD and relative preserved LVF undergoing PCI.

Show MeSH
Related in: MedlinePlus