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Blood test can accurately diagnose heart failure in patients with kidney dysfunction
December 15, 2005NT-proBNP test results comparable to those of BNP blood test in patients with kidney disease
A large-scale analysis has shown that a blood test previously found useful in diagnosing or ruling out heart failure in emergency room patients remains effective in patients with chronic kidney disease. The study also demonstrates that the test for a marker called NT-proBNP can identify patients at a higher risk for death, independent of kidney dysfunction. The report from investigators at the Massachusetts General Hospital (MGH) will appear in the January 3, 2006 Journal of the American College of Cardiology and is receiving early online release.
"It is well understood that kidney disease reduces the usefulness of testing for both NT-proBNP and a related biomarker called BNP, and the conventional understanding was that NT-proBNP was the more affected of the two," says James Januzzi Jr., MD, of the MGH Cardiology Division, the paper's senior author. "However, while kidney disease did lead to higher values of NT-proBNP in our study, what really matters is clinical performance; and at optimal cut-points, no matter how hard we looked, we found the relationship between chronic kidney disease and the diagnostic accuracy of NT-proBNP was no different than that of BNP. Our findings thus directly contradict observations based on smaller, less characterized patient populations."
Congestive heart failure, which occurs when an impaired heart muscle cannot pump blood efficiently, is a growing health problem and major cause of cardiac death. The diagnosis of heart failure may be challenging because its symptoms can overlap those of other conditions. Missing a heart failure diagnosis can put patients at high risk of serious problems, including death, but overdiagnosis may lead patients to receive unnecessary treatment.
Published earlier this year, the PRIDE study showed NT-proBNP to be highly sensitive and specific for the diagnosis of acute heart failure in patients with shortness of breath and to strongly predict patient deaths. A major concern about the widespread use of the marker had been previous assertions that kidney disease - very common in patients with heart failure - might confound the results of NT-proBNP testing, since levels of the marker were higher among those with reduced renal function.
Some researchers in the field argued that BNP was less affected by chronic kidney disease than was NT-proBNP. "We found no difference in our results when you examine them side-by-side with those for BNP," says Januzzi. "When you consider the data in totality, there just does not seem to be much difference between these two markers with respect to their diagnostic usefulness in patients with kidney disease. While kidney disease modestly reduces the diagnostic accuracy of both markers, when used in the appropriate manner, both tests appear to return identical information."
Besides the diagnostic value of NT-proBNP, the analysis evaluated the prospective value of NT-proBNP testing for predicting death within 60 days. "In fact, NT-proBNP measurement was an even stronger predictor of death in breathless patients with significant renal insufficiency, emphasizing the fact that the marker is likely detecting a true signal of cardiac disease in these patients," said Januzzi, an assistant professor of Medicine at Harvard Medical School. "This is a big step forward in the understanding of the optimal application of NT-proBNP measurement, as it removes one of the biggest obstacles that remained for the marker."
Massachusetts General Hospital
Congestive heart failure, which occurs when an impaired heart muscle cannot pump blood efficiently, is a growing health problem and major cause of cardiac death. The diagnosis of heart failure may be challenging because its symptoms can overlap those of other conditions. Missing a heart failure diagnosis can put patients at high risk of serious problems, including death, but overdiagnosis may lead patients to receive unnecessary treatment.
Published earlier this year, the PRIDE study showed NT-proBNP to be highly sensitive and specific for the diagnosis of acute heart failure in patients with shortness of breath and to strongly predict patient deaths. A major concern about the widespread use of the marker had been previous assertions that kidney disease - very common in patients with heart failure - might confound the results of NT-proBNP testing, since levels of the marker were higher among those with reduced renal function.
Some researchers in the field argued that BNP was less affected by chronic kidney disease than was NT-proBNP. "We found no difference in our results when you examine them side-by-side with those for BNP," says Januzzi. "When you consider the data in totality, there just does not seem to be much difference between these two markers with respect to their diagnostic usefulness in patients with kidney disease. While kidney disease modestly reduces the diagnostic accuracy of both markers, when used in the appropriate manner, both tests appear to return identical information."
Besides the diagnostic value of NT-proBNP, the analysis evaluated the prospective value of NT-proBNP testing for predicting death within 60 days. "In fact, NT-proBNP measurement was an even stronger predictor of death in breathless patients with significant renal insufficiency, emphasizing the fact that the marker is likely detecting a true signal of cardiac disease in these patients," said Januzzi, an assistant professor of Medicine at Harvard Medical School. "This is a big step forward in the understanding of the optimal application of NT-proBNP measurement, as it removes one of the biggest obstacles that remained for the marker."
Massachusetts General Hospital
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Young athletes need dual screening tests for heart defects, study suggests
To best detect early signs of life-threatening heart defects in young athletes, screening programs should include both popular diagnostic tests, not just one of them, according to new research from heart experts at Johns Hopkins.
New class of molecules may help prevent fatal complication in patients with kidney disease
Researchers at the University of Maryland School of Medicine have made an important discovery about why potassium builds up to dangerous levels in the bloodstream, a relatively common medical problem that affects about eight percent of hospitalized patients.
Reduction in glycotoxins from heat-processing of foods reduces risk of chronic disease
Researchers from Mount Sinai School of Medicine report that cutting back on the consumption of processed and fried foods, which are high in toxins called Advanced Glycation End products (AGEs), can reduce inflammation and actually help restore the body's natural defenses regardless of age or health status.
Help your kidneys: Pass on salt and diet soda
Individuals who consume a diet high in sodium or artificially sweetened drinks are more likely to experience a decline in kidney function, according to two papers being presented at the American Society of Nephrology's annual meeting in San Diego, California.
Can charcoal fight heart disease in kidney patients?
Charcoal may provide a new approach to managing the high rate of heart disease in patients with advanced kidney disease, according to preliminary research being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, CA.
Women with chronic kidney disease more likely than men to go undiagnosed
Woman are at particular risk of their primary care physicians delaying diagnosis of chronic kidney disease (CKD), according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, California.
For dialysis patients, skinny is dangerous
Dialysis patients with low body fat are at increased risk of death-even compared to patients at the highest level of body fat percentage, according to research being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego.
Protein critical for insulin secretion may be contributor to diabetes
A cellular protein from a family involved in several human diseases is crucial for the proper production and release of insulin, new research has found, suggesting that the protein might play a role in diabetes.
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