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Abstract: PO0983

Comparison of Natriuretic Peptides as Risk Markers for Mortality and Cardiovascular and Renal Complications in Persons with Type 1 Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Tofte, Nete, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Theilade, Simone, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Winther, Signe Abitz, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Goetze, Jens P., Rigshospitalet, Kobenhavn, Denmark
  • Hansen, Tine, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Background

Assessment of natriuretic peptides, N-terminal pro-brain natriuretic peptide (NT-proBNP) and Midregional Proatrial Natriuretic Peptide (MR-proANP), represents a useful addition for evaluating risk of cardiovascular and renal complications. Only very few studies have compared these two risk markers. We compared the value of NT-proBNP and MR-proANP as risk markers for mortality and development of cardiovascular and renal complications in persons with type 1 diabetes (T1D).

Methods

Plasma NT-proBNP and MR-proANP were measured (using commercially available kits) in 664 persons with T1D and various degrees of albuminuria. Endpoints were traced through National Registers and laboratory records and comprised mortality (n=57), composite cardiovascular events (CVE, n=94), heart failure (HF, n=27), end-stage kidney disease (ESKD, n=21) and decline in estimated glomerular filtration rate (eGFR) ≥30% (n=93). Median follow-up ranged from 5.1-6.2 years. From Cox regression models Hazard ratios (HRs) were assessed per doubling of NT-proBNP or MR-proANP with 95% confidence interval in models adjusted for cardiovascular risk factors: sex, age, systolic blood pressure, LDL-cholesterol, smoking, HbA1c, BMI, eGFR and urinary albumin excretion rate and additionally with mutual inclusion of MR-proANP and NT-proBNP.

Results

Of the 664 persons (55% male), mean±SD age was 55±13 years, eGFR 81±26 ml/min/1.73m2, median (IQR) MR-proANP was 74 (49-116) pmol/L and NT-proBNP 70 (29-162) pg/L. Higher NT-proBNP level was associated with higher risk of mortality (HR 1.5 (1.2-1.8)), CVE (HR 1.3 (1.1-1.5)) and HF (HR 1.7 (1.3-2.1)) independent of cardiovascular risk factors (p<0.001) and MR-proANP (p<0.004). Higher MR-proANP level was associated with higher risk of mortality (HR 1.7 (1.1-2.7)), CVE (HR 1.6 (1.1-2.2)), HF (HR 2.8 (1.5-5.2)) and ESKD (HR 3.1 (1.2-7.8)) independent of cardiovascular risk factors (p<0.03), however, after addition of NT-proBNP significance for all endpoints was lost. None of the markers were significantly associated with decline in eGFR ≥30%.

Conclusion

Higher NT-proBNP concentration was independently associated with mortality and cardiovascular events. Our results suggest that NT-proBNP may be useful singly or in combination with MR-proANP for risk-stratification in persons with T1D.

Funding

  • Private Foundation Support