Weitere Artikel dieser Ausgabe durch Wischen aufrufen
Qiwei Zhu and Suyan Bian contributed equally to this work.
The N‑terminal pro-brain natriuretic peptide (NT-proBNP) has an important prognostic value in chronic renal insufficiency; however, most studies have been conducted in patients with end-stage renal disease (ESRD). In this study we evaluated the prognostic significance of NT-proBNP in very old patients with stage 3 chronic kidney disease (CKD) and compared its prognostic value in CKD3a versus CKD3b patients.
Patients (age ≥80 years old) hospitalized with stage 3 CKD from 2007 to 2010 who were eligible for this prospective study underwent follow-up examinations in 2015. The examinations included measurements of anthropometric characteristics, blood pressure, plasma NT-proBNP, creatinine, and lipids. End-point events were all-cause death and major adverse cardiac events (MACEs).
A total of 168 patients (mean age 87.4 ± 2.9 years, range 80–99 years) were included in the analysis (CKD3a, n = 117; CKD3b, n = 51). The results showed that CKD3b was associated with lower hemoglobin levels, higher NT-proBNP levels and a higher rate of hypertension compared with CKD3a. After a median follow-up of 3.8 years (interquartile range 1.5–6.1 years), a higher NT-proBNP level was associated with a higher risk of all-cause death (hazard ratio HR 1.986, 95% confidence interval CI 1.276–2.819, p = 0.028) and MACEs (HR 2.872, 95% CI 1.241–6.644, p = 0.014) after adjusting for age, sex, and traditional risk factors; however, a subgroup comparison showed that elevated NT-proBNP levels were associated with a higher risk of all-cause death (HR 2.350, 95% CI 1.906–6.091, p = 0.039) and MACEs (HR 3.025, 95% CI 1.024–8.940, p = 0.045) in CKD3a but not CKD3b.
Levels of NT-proBNP increased with decreased renal function in very old patients with stage 3 CKD; therefore, NT-proBNP is an independent predictor for all-cause death and MACEs in these patients but has a greater prognostic value in CKD3a than in CKD3b.
Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten
Sie möchten Zugang zu diesem Inhalt erhalten? Dann informieren Sie sich jetzt über unsere Produkte:
Chudek J, Wieczorowska-Tobis K, Zejda J et al (2014) The prevalence of chronic kidney disease and its relation to socioeconomic conditions in an elderly Polish population: results from the national population-based study PolSenior. Nephrol Dial Transplant 29(5):1073–1082 CrossRef
Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822 CrossRef
Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P (2007) Prevalence of chronic kidney disease in the United States. J Am Med Assoc 298(17):2038–2047 CrossRef
Nadir MA, Witham MD, Szwejkowski BR, Struthers AD (2011) Meta-analysis of B‑type natriuretic peptide’s ability to identify stress induced myocardial ischemia. Am J Cardiol 107(5):662–667 CrossRef
Locatelli F, Hannedouche T, Martin-Malo A, Jacobson SH, Vanholder R, Ronco C (2013) The relationship of NT-proBNP and dialysis parameters with outcome of incident haemodialysis patients: results from the membrane permeability outcome study. Blood Purif 35(1–3):216–223 CrossRef
Oh HJ, Lee MJ, Kwon YE, Park KS, Park JT, Han SH (2015) Which biomarker is the best for predicting mortality in incident peritoneal dialysis patients: NT-proBNP, cardiac TnT, or hsCRP? Medicine (Baltimore) 94(44):e1636 CrossRef
Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL (2003) Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol 41(1):47–55 CrossRef
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463 CrossRef
Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17(10):2937–2944 CrossRef
Kidney Disease: Improving Global Outcomes(KDIGO) CKD Work Group (2013) KIDGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3(1):1–150 CrossRef
Hu Y, Wu XL, Hu ZH (1999) Research on the formula of human body surface area in China. J Physiol 51(1):45–48
Hu J, Wallace DC, Jones E, Liu H (2009) Cardiometabolic health of Chinese older adults with diabetes living in Beijing, China. Public Health Nurs 26(6):500–511 CrossRef
Hallan SI, Coresh J, Astor BC, Asberg A, Powe NR, Romundstad S (2006) International comparison of the relationship or chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol 17(8):2275–2284 CrossRef
Lin MY, Chiu YW, Lee CH, Yu HY, Chen HC, Wu MT (2013) Factors associated with CKD in the elderly and nonelderly population. Clin J Am Soc Nephrol 8(1):33–40 CrossRef
James MT, Hemmelgarn BR, Tonelli M (2010) Early recognition and prevention of chronic kidney disease. Lancet 375(9722):1296–1309 CrossRef
Gansevoort RT, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS (2011) Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int 80(1):93–104 CrossRef
Van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey A (2011) Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int 79(12):1341–1352 CrossRef
Wang AY, Lai KN (2008) Use of cardiac biomarkers in end-stage renal disease. J Am Soc Nephrol 19(9):1643–1652 CrossRef
Zhu Q, Xiao W, Bai Y, Ye P, Luo L, Gao P (2016) The prognostic value of the plasma N‑terminal pro-brain natriuretic peptide level on all-cause death and major cardiovascular events in a community-based population. Clin Interv Aging 11:245–253 CrossRef
Laukkanen JA, Kurl S, la-Kopsala M, Vuolteenaho O, Ruskoaho H, Nyyssönen K (2006) Plasma N‑terminal fragments of natriuretic propeptides predict the risk of cardiovascular events and mortality in middle-aged men. Eur Heart J 27(10):1230–1237 CrossRef
Couser WG, Remuzzi G, Mendis S, Tonelli M (2011) The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 80(12):1258–1270 CrossRef
Hemmelgarn BR, Manns BJ, Lloyd A, James MT, Klarenbach S, Quinn RR (2010) Relation between kidney function, proteinuria, and adverse outcomes. JAMA 303(5):423–429 CrossRef
Sakuma M, Nakamura M, Tanaka F, Onoda T, Itai K, Tanno K (2010) Plasma B‑type natriuretic peptide level and cardiovascular events in chronic kidney disease in a community-based population. Circ J 74(4):792–797 CrossRef
Fu S, Luo L, Ye P, Yi S, Liu Y, Zhu B (2013) The ability of NT-proBNP to detect chronic heart failure and predict all-cause mortality is higher in elderly Chinese coronary artery disease patients with chronic kidney disease. Clin Interv Aging 8:409–417 CrossRef
Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D (2011) A predictive model for progression of chronic kidney disease to kidney failure. JAMA 305(15):1553–1559 CrossRef
Cichocka-Radwan A, Ciurus T, Lelonek M (2014) The impact of chronic kidney disease on the annual prognosis in patients 80+ years old suffering from chronic heart failure. Kardiochir Torakochir Pol 11(3):294–300
Lamb EJ, O’Riordan SE, Webb MC, Newman DJ (2003) Serum cystatin C may be a better marker of renal impairment than creatinine. J Am Geriatr Soc 51(11):1674–1675 CrossRef
- Prognostic value of plasma NT-proBNP levels in very old patients with moderate renal insufficiency in China
- Springer Medizin