Diagnostic and prognostic relevance of B-type natriuretic peptide (BNP) and N-terminal proBNP in patients with AL amyloidosis and renal failure Background. In AL amyloidosis prognosis depends on heart involvement and natriuretic peptides type-B (BNP and NT-proBNP) are used to assess cardiac dysfunction and predict survival. However, their clearance relies on glomerular filtration rate (GFR) and their concentration increases with renal failure. We consecutively evaluated the diagnostic and prognostic performance of NT-proBNP and BNP in 248 patients with AL amyloidosis with normal renal function and different degrees of renal failure. Methods. Patients were grouped according to estimated GFR (eGFR). Group 1 comprised 109 patients with eGFR ≥60 mL/min/1.73m2, Group 2, 77 subjects with eGFR <60 and ≥15 mL/min/1.73m2, and Group 3, 62 patients with eGFR <15 mL/min/1.73m2. Heart involvement was defined according to consensus criteria. Results. Decreasing eGFR required higher NT-proBNP cutoffs for detecting heart involvement (332 ng/L in Group 1, 543 ng/L in Group 2, 2642 ng/L in Group 3) and predicting survival (1149 ng/L in Group 1, 4409 ng/L in Groups 2 and 3). Also BNP diagnostic (73 ng/L in Groups 1 and 2 and 221 ng/L in Group 3) and prognostic (228 ng/L in Groups 1 and 2 and 509 ng/L in Group 3) cutoffs increased with decreasing eGFR. Both natriuretic peptides independently predicted survival in Groups 1 and 2, whereas in Group 3 only BNP was an independent prognostic marker. Conclusion. Natriuretic peptides are powerful markers of cardiac dysfunction and prognosis, provided that eGFR is considered in interpreting their clinical meaning. However, BNP should be preferred in patients with end-stage renal failure.
La rilevanza diagnostica e prognostica del peptide natriuretico di tipo B (BNP) e del suo frammento N terminale (NT-proBNP) nei pazienti con amiloidosi AL e insufficienza renale
PALLADINI, GIOVANNI;PERLINI, STEFANO;ALBERTINI, RICCARDO;MERLINI, GIAMPAOLO
2010-01-01
Abstract
Diagnostic and prognostic relevance of B-type natriuretic peptide (BNP) and N-terminal proBNP in patients with AL amyloidosis and renal failure Background. In AL amyloidosis prognosis depends on heart involvement and natriuretic peptides type-B (BNP and NT-proBNP) are used to assess cardiac dysfunction and predict survival. However, their clearance relies on glomerular filtration rate (GFR) and their concentration increases with renal failure. We consecutively evaluated the diagnostic and prognostic performance of NT-proBNP and BNP in 248 patients with AL amyloidosis with normal renal function and different degrees of renal failure. Methods. Patients were grouped according to estimated GFR (eGFR). Group 1 comprised 109 patients with eGFR ≥60 mL/min/1.73m2, Group 2, 77 subjects with eGFR <60 and ≥15 mL/min/1.73m2, and Group 3, 62 patients with eGFR <15 mL/min/1.73m2. Heart involvement was defined according to consensus criteria. Results. Decreasing eGFR required higher NT-proBNP cutoffs for detecting heart involvement (332 ng/L in Group 1, 543 ng/L in Group 2, 2642 ng/L in Group 3) and predicting survival (1149 ng/L in Group 1, 4409 ng/L in Groups 2 and 3). Also BNP diagnostic (73 ng/L in Groups 1 and 2 and 221 ng/L in Group 3) and prognostic (228 ng/L in Groups 1 and 2 and 509 ng/L in Group 3) cutoffs increased with decreasing eGFR. Both natriuretic peptides independently predicted survival in Groups 1 and 2, whereas in Group 3 only BNP was an independent prognostic marker. Conclusion. Natriuretic peptides are powerful markers of cardiac dysfunction and prognosis, provided that eGFR is considered in interpreting their clinical meaning. However, BNP should be preferred in patients with end-stage renal failure.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
