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Role of N-Terminal Pro-Brain Natriuretic Peptide and Cystatin C to Estimate Renal Function in Patients With and Without Heart Failure
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| 03.05.2009, 14:47 |
Blood cystatin C has increasingly been used as an endogenous marker for estimating
glomerular filtration rate (GFR) and evaluating prognosis in patients with acute or chronic
heart failure. The goal of the study was to investigate the impact of heart failure on the
determination of renal function based on cystatin C or creatinine in nonacute cardiac
patients. A total of 880 consecutive and clinically stable patients with heart disease were
prospectively evaluated. Serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP)
showed a stronger correlation with cystatin C (r 0.60, p <0.001) compared with
creatinine (r 0.46, p <0.001). Multivariate analysis identified estimated GFR according
to the MDRD Study formula (p <0.001), serum NT-pro-BNP (p <0.001), use of immunosuppressive
agents (p <0.001), and allopurinol treatment (p <0.001) as the strongest
independent predictors of serum cystatin C. Parallel measurement of creatinine clearance
using timed urine collection in a subgroup of 160 patients showed that estimated GFR
according to cystatin C was almost identical to measured creatinine clearance independent
of NT-proBNP. Conversely, creatinine-based calculation using the MDRD Study formula
underestimated GFR in patients from the low (12 to 238 pg/ml) and medium (241 to 990
pg/ml) NT-pro-BNP tertiles. In conclusion, in patients without severe heart failure, indicated
by low serum NT-pro-BNP, estimation of GFR using creatinine-based formulas
underestimated renal function. The known prognostic impact of cystatin C in cardiac
patients might result from a strong correlation with NT-pro-BNP, as well as its superior
ability to predict renal function in patients with and without heart failure. © 2009
Elsevier Inc. (Am J Cardiol 2009;103:1128 –1133)
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| Категория: Статьи | Добавил: nbylova
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