在日本慢性肾脏病患者中，血浆B型利钠肽浓度与肾功能下降独立相关。

Plasma B-type natriuretic peptide concentration is independently associated with kidney function decline in Japanese patients with chronic kidney disease.

作者信息

Yoshitomi Ryota, Nakayama Masaru, Sakoh Teppei, Fukui Akiko, Shikuwa Yui, Tominaga Mitsuhiro, Tsuchihashi Takuya, Tsuruya Kazuhiko, Kitazono Takanari

机构信息

aDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku bDivision of Nephrology and Clinical Research Institute cDivision of Hypertension and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, 1-8-1 Jigyohama, Chuo-ku dDivision of Cardiology and Hypertension, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Fukuoka 805-8508, Japan.

出版信息

J Hypertens. 2016 Apr;34(4):753-61. doi: 10.1097/HJH.0000000000000847.

DOI:10.1097/HJH.0000000000000847

PMID:26828787

Abstract

BACKGROUND AND OBJECTIVE

The relationship between B-type natriuretic peptide (BNP) concentration and renal outcomes in patients with chronic kidney disease (CKD) remains unclear; therefore, it has not been determined whether BNP is related to renal outcomes, independent of cardiac parameters. This study was designed to clarify whether BNP concentration is associated with renal outcomes in CKD patients, independent of cardiac functional and structural alterations.

METHODS

This prospective observational study included 372 consecutive patients with CKD. The renal endpoint was the composite of doubling of serum creatinine concentration and end-stage renal disease requiring dialysis. BNP concentrations were divided into quartiles. A Cox proportional hazards model was utilized to determine the risk factors for poor renal outcomes.

RESULTS

During a median follow-up of 23.1 months, the renal endpoint was observed in 124 patients, including 14, 18, 37 and 55 patients in the first through fourth BNP quartiles, respectively. After adjustment for covariates, including cardiac parameters such as left atrial diameter, left ventricular mass index, left ventricular ejection fraction, and left ventricular hypertrophy, the hazard ratios (HRs) for renal outcomes became progressively higher for the second [HR, 1.50; 95% confidence interval (CI), 0.70-3.30), third (HR, 2.29; 95% CI, 1.11-4.91), and fourth (HR, 4.29; 95% CI, 2.05-9.39) BNP quartiles when compared with the lowest BNP quartile.

CONCLUSION

Higher BNP levels were associated with adverse renal outcomes, independent of cardiac structure and function, suggesting that BNP may be a useful biomarker for exploring factors associated with kidney disease progression.

摘要

背景与目的

慢性肾脏病（CKD）患者中B型利钠肽（BNP）浓度与肾脏结局之间的关系仍不明确；因此，尚未确定BNP是否独立于心脏参数与肾脏结局相关。本研究旨在阐明BNP浓度是否独立于心脏功能和结构改变与CKD患者的肾脏结局相关。

方法

这项前瞻性观察性研究纳入了372例连续的CKD患者。肾脏终点是血清肌酐浓度翻倍和需要透析的终末期肾病的复合指标。BNP浓度分为四分位数。采用Cox比例风险模型确定肾脏不良结局的危险因素。

结果

在中位随访23.1个月期间，124例患者出现肾脏终点，其中第一至第四BNP四分位数组分别有14、18、37和55例患者。在对包括左心房直径、左心室质量指数、左心室射血分数和左心室肥厚等心脏参数在内的协变量进行调整后，与最低BNP四分位数组相比，第二（风险比[HR]，1.50；95%置信区间[CI]，0.70 - 3.30）、第三（HR，2.29；95% CI，1.11 - 4.91）和第四（HR，4.29；95% CI，2.05 - 9.39）BNP四分位数组的肾脏结局风险比逐渐升高。