[Diagnostic Ability of Natriuretic Peptides for Heart Failure According to eGFR Level: Comparison between Brain Natriuretic Peptide and Amino-Terminal Probrain Natriuretic Peptide].

Abstract Although the influence of reduced kidney function on natriuretic peptides (B-type natriuretic peptide [BNP] and amino terminal probrain natriuretic peptide [NT]) is clear, effect of kidney function on the difference of diagnostic ability for heart failure by these peptides is not obvious. The aim of this study was to examine the relationship between natriuretic peptide concentrations and echocardiographic findings according to eGFR level of the patients. In addition, we compared diagnostic ability of BNP with that of NT according to eGFR level. The eGFR levels were classified by based on CKD stage (≥ 60, 45-59, 30-44, 15-29, < 15 and on maintenance HD). Patients who underwent the measurements of BNP, NT and serum creatinine concentrations, as well as echocardiography between March and October in 2011 were enrolled (n = 1,297). The left ventricular mass index was greater in patients with eGFR < 60 than in those with eGFR ≥ 60, but EF (%) was not different among eGFR level (except eGFR30-44). The percentage of patients with heart failure in those with eGFR < 60 (16.0%) was more than eGFR ≥ 60 (5.8%). Median BNP and NT concentrations were elevated in association with decreasing eGFR level. Using receiver-operator characteristic (ROC) analysis, the area under the ROC curve for BNP and NT that stratified subjects with or without heart failure was not different among eGFR level. In conclusion, BNP and NT levels are elevated depend on decreasing eGFR level, BNP and NT are comparable in the accuracy for diagnosing heart failure at every eGFR level. The cut-off value of BNP and NT should be established according to the eGFR level.