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Original ArticlesChronic Kidney Disease
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Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant

Matthew A. Roberts, David L. Hare, Ken Sikaris and Francesco L. Ierino
CJASN June 2014, 9 (6) 1024-1032; DOI: https://doi.org/10.2215/CJN.08640813
Matthew A. Roberts
*Department of Renal Medicine, Eastern Health Clinical School, Monash University, Victoria, Australia;
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David L. Hare
†Department of Medicine, University of Melbourne, Victoria, Australia;
‡Department of Cardiology, and
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Ken Sikaris
§Melbourne Pathology Service, Collingwood, Victoria, Australia
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Francesco L. Ierino
†Department of Medicine, University of Melbourne, Victoria, Australia;
‖Department of Nephrology, Austin Health, Victoria, Australia; and
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  • Figure 1.
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    Figure 1.

    Concentrations of NT-BNP-76 (A) measured at baseline (sample 1) and 5–6 months later (sample 2) increased in patients with CKD and dialysis patients, but not kidney transplant recipients. For BNP-32 (B), no significant change was detected. The median and interquartile ranges are based on natural logarithm–transformed values of B-type natriuretic peptide (BNP) and actual values are given on the y axis. The whiskers represent the data point closest to 1.5 times the interquartile range away from the nearer quartile. BNP-32, 32–amino acid BNP; NT-BNP-76, N-terminal end BNP.

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    Figure 2.

    Survival was significantly reduced in patients with the greatest tertile of change of NT-BNP-76 for CKD stages 3–4 (A), but not dialysis patients (B).

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    Figure 3.

    Concentrations of both BNP-32 (A) and NT-BNP-76 (B) were reduced after kidney transplantation. Each line represents an individual patient. Time zero is the date of transplant.

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    Table 1.

    Baseline characteristics of the patients who had two measurements of NT-BNP-76 by treatment group

    CharacteristicCKD 3–4 (n=49)Dialysis (n=102)Transplant (n=71)P Value
    Age (yr)67.1±11.262.6±14.352.8±10.7<0.001
    Men37 (76)60 (59)46 (63)0.13
    Diabetes21 (43)20 (20)8 (11)<0.001
    Cardiovascular disease19 (39)32 (31)9 (13)0.003
    Coronary artery disease15 (31)24 (24)4 (6)0.001
    Heart failure8 (16)19 (19)1 (1)0.002
    Cerebrovascular disease1 (2)7 (7)2 (3)0.29
    Peripheral vascular disease8 (16)16 (16)3 (4)0.05
    Smoking30 (61)55(54)36 (51)0.52
    Systolic BP (mmHg)132±21145±24129±14<0.001
    Diastolic BP (mmHg)76±978±1377±60.46
    BMI (kg/m2)27.3 (24.2–31.8)24.2 (21.8–27.4)26.5 (23.3–29.8)<0.001
    Antiplatelet agent24 (49)39 (38)15 (21)<0.01
    RAS blockade33 (67)39 (38)41 (58)0.001
    Statin26 (53)46 (45)44 (62)0.09
    β-Blocker17 (35)35 (34)35 (49)0.11
    eGFR (ml/min per 1.73 m2)24±11—35±16<0.001
    Hemoglobin (g/dl)12.3±1.612.1±1.212.9±1.90.003
    C-reactive protein (mg/L)3.8 (1.8–7.6)5.0 (3.0–11.8)1.6 (0.6–4.6)<0.001
    Albumin (g/dl)4.01±0.393.76±0.414.12±0.32<0.001
    cTnT-positive (sample 1)9 (19)48 (47)6 (8)<0.001
    cTnT-positive (sample 2)10 (21)59 (58)8 (11)<0.001
    • Results are similar for patients with two measurements of 32–amino acid BNP (data not shown). Values expressed with a plus/minus sign are the mean±SD; all other values are the number (percentage) of patients. NT-BNP-76, N-terminal end B-type natriuretic peptide; BMI, body mass index; RAS, renin-angiotensin system; cTnT-positive, cardiac troponin T≥0.04 ng/ml.

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    Table 2.

    Median (interquartile range) concentrations of BNP-32 and NT-BNP-76 at baseline (first sample) and 5–6 months later (second sample) and median difference between the two by treatment group

    VariableCKD 3–4 Dialysis Transplant
    BNP-32 (pg/ml)n=48n=102n=73
     First sample102 (48–252)218 (93–445)66 (41–148)
     Second sample103 (34–269)280 (116–668)61 (31–161)
     ΔBNP-32−9 (−47 to 39)13 (−66 to 171)−4 (−20 to 19)
    NT-BNP-76 (pg/ml)n=49n=102n=71
     First sample698 (283 to 2,922)3850 (1776–12,323)379 (141–875)
     Second sample2529 (347–9277)a18,830 (6114– 61,009)b347 (144–981)
     ΔNT-BNP-76778 (−57 to 7468)13,772 (2058–41,244)2 (−74 to 105)
    • BNP-32, 32–amino acid BNP; BNP, B-type natriuretic peptide; ΔBNP, change between first and second samples.

    • ↵a P=0.004 compared with the first sample.

    • ↵b P<0.001 compared with the first sample.

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    Table 3.

    Summary of variables measured at baseline or sample 2 that were associated with change in BNP at the P≤0.05 level

    Variable and PredictorContinuous VariablesCategorical Variables
    β-Coefficient (95% CI)P ValueTertile 1, n (%)Tertile 2, n (%) Tertile 3, n (%) P Value
    NT-BNP-76
     CKD 3–4
      Male sex10 (60)11 (69)16 (100)0.02
      cTnT-positive  (sample 1)02 (13)7 (44)0.004
      cTnT-positive  (sample 2)02 (13)8 (50)0.001
     Dialysis
      SBP (mmHg)−0.01 (−0.02 to 0.0)0.05
      cTnT-positive  (sample 1)15 (44)11 (32)22 (65)0.03
      cTnT-positive  (sample 2)17 (50)15 (44)27 (79)<0.01
     KTR
      cTnT-positive  (sample 2)1 (4)07 (30)0.002
    BNP-32
     CKD 3–4
      logCRP (mg/L)−0.21 (−0.38 to −0.03)0.02
      Statin use10 (59)4 (27)11 (69)0.05
      cTnT-positive  (sample 2)4 (24)06 (18)0.04
     Dialysis
       Heart failure11 (32)2 (6)6 (18)0.02
     KTR
      Hemoglobin  (per 10 g/dl)−0.01 (−0.01 to 0.0)0.02
      Albumin  (per 1 g/dl)−0.04 (0.07 to 0.0)0.05
      cTnT-positive  (sample 1)1 (4)05 (21)0.02
      cTnT-positive  (sample 2)1 (4)07 (30)0.002
    • The β-coefficient is the change in the natural logarithm–transformed ratio of the second to the first BNP sample for each unit change of the variable presented. Categorical variables are presented as the number (percentage) in each progressive tertile of change in BNP. Actual BNP concentrations that define tertiles are available in Supplemental Table 3. SBP, systolic BP; KTR, kidney transplant recipient; CRP, C-reactive protein; 95% CI, 95% confidence interval.

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Clinical Journal of the American Society of Nephrology: 9 (6)
Clinical Journal of the American Society of Nephrology
Vol. 9, Issue 6
June 06, 2014
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Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant
Matthew A. Roberts, David L. Hare, Ken Sikaris, Francesco L. Ierino
CJASN Jun 2014, 9 (6) 1024-1032; DOI: 10.2215/CJN.08640813

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Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant
Matthew A. Roberts, David L. Hare, Ken Sikaris, Francesco L. Ierino
CJASN Jun 2014, 9 (6) 1024-1032; DOI: 10.2215/CJN.08640813
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