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NDT Advance Access published online on June 18, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn341
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Prognostic value of cardiac biomarkers for death in a non-dialysis chronic kidney disease population

Susan Vickery1, Michelle C. Webb2, Christopher P. Price3, Robert Ian John2, Nasir A. Abbas2 and Edmund J. Lamb1

1 Department of Clinical Biochemistry 2 Department of Renal Medicine, East Kent Hospitals NHS Trust, Canterbury, Kent, CT1 3NG 3 Department of Clinical Biochemistry, University of Oxford, Oxford, 0X3 9DU, UK

Correspondence and offprint requests to: Susan Vickery, Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Canterbury, Kent, CT1 3NG, UK. Tel: +44-1227-766877 Ext: 74736; Fax: +44-1227-783077; E-mail: susan.vickery{at}ekht.nhs.uk



  Abstract

Background. Excess mortality in patients with chronic kidney disease (CKD) is predominantly due to cardiovascular disease. We explored the prognostic value of biomarkers of cardiac overload [B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] and inflammation [high-sensitivity C-reactive protein (hsCRP)] for all-cause mortality in patients with CKD.

Methods. Plasma BNP (Siemens Medical Solutions Diagnostics, Frimley, Surrey, UK) and NT-proBNP (Roche Diagnostics PLC, East Sussex, UK), and hsCRP (Siemens Medical Solutions Diagnostics) were measured at study entry. Echocardiograms were undertaken, and left ventricular mass index (LVMI) was calculated. CKD patients (n = 213) were followed for up to 53 months. Kaplan–Meier survival analysis with log-rank testing and hazards ratios (HRs) were calculated for each cardiac biomarker, stratified by respective median values, as a predictor of death to assess outcome.

Results. Fifty-four deaths occurred. NT-proBNP concentration ≥89 pmol/L (HR 5.6, P < 0.0001), BNP concentration ≥14 pmol/L (HR 3.5, P < 0.001), NT-proBNP/BNP ratio ≥6 pmol/pmol (HR 2.6, P < 0.01) and hsCRP concentration ≥4.7 mg/L (HR 2.4, P < 0.01) were unadjusted predictors of death. Only NT-proBNP ≥89 pmol/L (HR 2.5, P < 0.05) and hsCRP ≥4.7 mg/L (HR 1.9, P < 0.05) were independent predictors of death when the HRs were adjusted for significant clinical variables (age, estimated glomerular filtration rate, LVMI and vascular disease).

Conclusion. NT-proBNP and hsCRP can independently predict all-cause mortality in a non-dialysis CKD population and may have a useful role in risk stratification.

Keywords: B-type natriuretic peptides; chronic kidney disease; high-sensitivity CRP

Received for publication: 30. 7.07
Accepted in revised form: 22. 5.08


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