The Prognostic value of N-Terminal-ProBrain Natriuretic Peptide in the Diagnosis and to Detect the Progression of Left Ventricular Mass and Function in Patients with Chronic Kidney Disease

摘要

Introduction: Mild renal dysfunction is an important cardiovascular risk factor predispose to coronary heart disease. In recent years natriuretic peptides have become promising candidates in the early detection of cardiovascular disease (CVD) such as heart failure. In end stage renal disease (ESRD) patients, the clinical benefit of N-terminal probrain natriuretic peptide (NT-proBNP) measurements has not been well established. Aim of the study: Is to evaluate the role of serum NT-proBNP levels in diagnoses and to detect the progression of left ventricular dysfunction and left ventricular mass in a sizable cohort of stable patients on chronic HD without clinical signs of progressive heart failure. Patients and methods: This study was conducted on 100 persons, 55 were known as ESRD patients on regular conventional hemodialysis (HD) [Dialysis group] and 25 patients with chronic kidney disease(CKD) not on HD [CKD group] in addition to 20 healthy volunteers [control group]. All participants were thoroughly interrogated and examined clinically and were subjected to plasma NT-proBNP level and transthoracic echocardiography at baseline and after six months. Results: Mean NT-proBNP showed significantly higher mean in dialysis group (252.88 ±125.193 fmol/ml) compared to the CKD group(168.266 ±134.881fmol/ml[P=0.007], and the control group(9.075±6.707fmol/ml)[PPPP<0.001).Conclusion: The study recommended that plasma NT-proBNP assessment is an easy non invasive test and should be monitored in HD patients owing to its close relation to LVM, systolic dysfunction and cardiovascular morbidity and mortality in this population. Rising NT-proBNP levels may reflect worsening ventricular stress and may help earlier diagnostic and therapeutic strategies.