Although brain natriuretic peptide (BNP) concentration has been associated with atherosclerosis and ischemic cardiovascular diseases (CVD) in the general population, less is known about this relationship in pre-dialysis chronic kidney disease (CKD) patients.
We prospectively analyzed 227 pre-dialysis patients with CKD [median estimated glomerular filtration rate (eGFR): 28.82 (11.65–48.20) ml/min/1.73 m2]. At enrollment, BNP concentrations, biochemical and echocardiographic parameters were measured, and carotid artery ultrasound was performed. Patients were prospectively followed for a mean 31.8 months (range 0.5–57.0 months). Ischemic CV events and patient outcomes were recorded.
Median BNP concentration at enrollment was significantly higher in the CKD patients than in a control group [53.9 (16.2–181.0) pg/ml vs. 9.4 (7.0–15.3) pg/ml, P<0.01]. BNP concentration was positively related with the carotid intima–media thickness of the common carotid artery (CCA-IMT) and left ventricular mass index (LVMI) and was significantly higher in patients with than without carotid plaques (P<0.01). Logistic regression analysis confirmed that lgBNP concentration was independently correlated with carotid plaques. Thirty-two patients experienced ischemic cardiovascular (ICV) events during follow-up. Kaplan–Meier analysis showed that cumulative survival without new ICV events was better in patients with lower than with higher BNP concentrations (P<0.01). Cox regression analysis showed that BNP was an independent risk factor for ICV events (HR=3.167, 95%CI=1.398–7.171, P<0.01).
Similar to findings in the general population, elevated BNP level is related to atherosclerosis and an increased risk of ICV events in pre-dialytic CKD patients.
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Published online: June 26, 2012
Accepted: June 4, 2012
Received in revised form: May 13, 2012
Received: January 10, 2012
© 2012 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.