Clinical utility of b-type natriuretic peptides in patients with heart failure and renal dysfunction

الملخص EN

Background : Increased plasma level of B-type Natriuretic peptide (BNP) in chronic kidney disease (CKD) and hemodialysis patients with volume overload and heart failure (HF) is common and de-creases during dialysis.

BNP and N-terminal pro-hormone B-type Natriuretic peptide (NT-proBNP) are established HF markers, but the concomitant presence of CKD changes their interpretation in a significant manner.

Aim : to evaluate the effect of compromised kidney function on the level of BNP in Egyptian patients with CKD and ESRD.

Patients and Methods : from June 2011 to June 2012, forty-seven patients (17 CKD patients on regular follow up and 30 ESRD patients on regular hemo-dialysis) were tested for serum BNP and Echocardiography.

Normal range of BNP was calculated from 17 apparently healthy individuals (control group).

Results : Plasma BNP was significantly higher in both CKD patients and ESRD patients compared to controls (p < 0.001).

In CKD group, BNP values did not differ between patients with normal diastolic function and those with impaired di-astolic function (p = 0.57).

However, in ESRD patients, BNP was significantly higher in patients with impaired diastolic function compared to those with normal diastolic function (p = 0.018).

A positive correlation was found between diastolic dysfunction and BNP levels in CKD patients (r = 0.45 ; p = 0.013).

Our study could not prove that the BNP could provide a certain cutoff value to di-agnose ventricular function.

BNP value for diagnosis of left ventricle systolic dysfunction was set at > 37 pg / ml (p = 0.08).

While, BNP value for diagnosis of left ventricle diastolic dysfunction was set at > 39.1 pg / ml (p = 0.24).

Conclusion : BNP can be considered as a diagnostic and prognostic test for diagnosis of HF in CKD and ESRD patients.

High plasma level of BNP may indicate the need for further pharmacological treatment for HF.