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Abstract: TH-PO463

The Cut-Off Value of NT-Pro BNP to Diagnose Cardiac Insufficiency with Both Decreased and Preserved Ejection Fraction Value in Patients with Stage 3 to 5D CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Author

  • Li, Zi, Department of Medicine-Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
Background

BNP and NT-Pro-BNP are widely used in clinical work for the diagnosis of heart failure even in patients with chronic kidney disease(CKD).
Previous research focused on the heart failure with decreased ejection fraction (EF). However, heart failure/insufficiency with preserved EF occurs in a large amout CKD patients especially in the early period. This research is to explore the diagnosis cut-off value of NT-Pro BNP for cardiac insufficiency in CKD patients with stage 3 to 5D, and to analyze its probable influential factors.

Methods

CKD patients with 3 to 5D stages who were hospitalized in the department of nephrology, which belongs to an affiliated hospital of our university, from April 2016 to April 2017 were enrolled. All the patients measured plasma NT-Pro BNP and completed echocardiography within 1 month. Criteria for heart insufficiency included both the patients’ symptoms, the 2013 ACCF/AHA heart failure guideline and recommendations and the American Society of Echocardiography as well. Informations of age, sex, weight, height, BMI, blood pressure, NT-ProBNP, GFR, serum electrolytes, index of echocardiography were collected. According to GFR, the patients are divided into three groups: CKD3, CKD4, CKD5 (non-dialysis, hemodialysis, and peritoneal dialysis). SPSS software is used for data analysis.

Results

(1) A total of 396 patients met our inclusion crtieria. NT-Pro BNP was negatively correlated with GFR, EF, sodium, potassium or chloride and positively correlated with E/A, LV, LA, RV, RA, IVS, LVPW, EDD, ESD, EDV, ESV and CKD stages (p<0.05). (2) Linear correlation analysis showed ESV, EF, ESD, EDV, E/A, NT-Pro BNP, LV, LA, E/e' correlated with heart failure; multi-factor logistic regression analysis showed that the factors affecting heart failure included E/A, ESV and NT-pro BNP. The diagnostic cut-point value of NT-pro BNP for heart insufficiency increased with the increase of CKD stage (CKD stage 3: 3654.0pg/ml; CKD stage 4: 7584.5pg/ml; CKD stage 5 non-dialysis: 9465.5pg/ml; peritoneal dialysis: 18667.5pg/ml; hemodialysis: 29362.0pg/ml).

Conclusion

NT-Pro BNP cut-off values for cardiac insufficiency should be established according to different CKD stages and considering both decreased and preserved EF value in order to improve early diagnosis and treatment of heart insufficiency.