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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2017: 3.556

CiteScore 2017: 2.34

SCImago Journal Rank (SJR) 2017: 1.114
Source Normalized Impact per Paper (SNIP) 2017: 1.188

Online
ISSN
1437-4331
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Volume 48, Issue 1

Issues

Improvement of the cardiac marker N-terminal-pro brain natriuretic peptide through adjustment for renal function: a stratified multicenter trial

Andreas Luchner
  • Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Regensburg, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Alexander Weidemann
  • Medizinische Klinik 4 mit Schwerpunkt Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Roland Willenbrock / Sebastian Philipp
  • Klinik für Kardiologie, Westdeutsches Herzzentrum der Universität Duisburg-Essen, Essen, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Norbert Heinicke
  • Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Regensburg, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Matthias Rambausek / Uta Mehdorn / Burkhard Frankenberger / Iris M. Heid / Kai-Uwe Eckardt
  • Medizinische Klinik 4 mit Schwerpunkt Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Stephan R. Holmer
  • Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Regensburg, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar

Abstract

Background: N-terminal-pro brain natriuretic peptide (NT-proBNP) is a useful cardiac marker that is also influenced by renal dysfunction. It was our objective to assess the relationship between NT-proBNP concentrations in plasma and worsening renal function, and to attempt adjustment of NT-proBNP for renal dysfunction in a prospective, stratified multi-center study.

Methods: We stratified 203 male patients according to their cardiac status and the estimated glomerular filtration rate (eGFR). Cardiac disease was assessed by medical history, physical examination and standardized echocardiography. Patients were stratified according to the following: absence of cardiac history and abnormalities (control, CTRL, n=66), cardiac history without left ventricular hypertrophy (LVH) or left ventricular systolic dysfunction (LVD) (history, n=30), LVH without systolic dysfunction (LVH, n=68), and LVD [ejection fraction (EF) <40%, LVD, n=39]. Renal disease was stratified according to the eGFR: 15–30 mL/min (n=52), 31–75 mL/min (n=99), and >75 mL/min (n=52).

Results: NT-proBNP was correlated with eGFR in the entire study population and for all levels of cardiac disease (all p<0.01). Regression analysis allowed adjustment of NT-proBNP for eGFR in a continuous manner, and this adjustment significantly improved the predictive value (receiver operating characteristic curve for symptomatic LVD from 0.80 to 0.86, p<0.01; sensitivity from 74% to 83% and specificity from 68% to 79%).

Conclusions: NT-proBNP correlates inversely and significantly with eGFR throughout all levels of cardiac strata. We propose for the first time a continuous adjustment algorithm which markedly improves the predictive values of NT-proBNP in male patients with impaired renal function.

Clin Chem Lab Med 2010;48:121–8.

Keywords: echocardiography; glomerular filtration; heart; kidney; natriuretic peptide

About the article

Corresponding author: Prof. Dr. Andreas Luchner, FESC, Klinik und Poliklinik für Innere Medizin II – Kardiologie, Klinikum der Universität, 93042 Regensburg, Germany Phone: +49 941 944-7211, Fax: +49 941 944-7213,


Received: 2009-03-03

Accepted: 2009-09-05

Published in Print: 2010-01-01


Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 48, Issue 1, Pages 121–128, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2010.011.

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