Key result
Plasma NT-proBNP is cleared by multiple tissues, with 55-65% of total clearance occurring in the kidney, 20-25% in the liver, 10-15% in musculoskeletal tissue, and 5-10% in the head and neck.
Observational (n=120)
NT-proBNP is cleared by multiple tissues, with 55-65% occurring in the kidneys, and renal extraction is sustained even with moderate kidney dysfunction.
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Non-renal NT-proBNP clearance may confound levels in multi-organ disease; leaves open refined thresholds for HF.
AIMS: Mechanisms for clearance of circulating amino-terminal pro-brain natriuretic peptide (NT-proBNP) remain poorly understood and are relevant to the clinical utility of NT-proBNP as a diagnostic and prognostic biomarker in cardiovascular disorders. We sought to determine site(s) of production and clearance of plasma NT-proBNP in the human circulation. METHODS AND RESULTS: In 120 subjects undergoing clinically indicated cardiac catheterization, blood samples were collected from arterial and multiple venous sites to measure transorgan gradients of plasma NT-proBNP. Clearance of plasma NT-proBNP occurred across kidney, liver, musculoskeletal, and head and neck tissues. Proportions of calculated total body NT-proBNP clearance were 55-65% across the kidney, 20-25% across the liver, 10-15% across musculoskeletal tissue, and 5-10% across the head and neck. Renal fractional extraction of NT-proBNP was unrelated to estimated glomerular filtration rate. Transorgan gradients, reflecting both renal and extra-renal NT-proBNP degradation, were correlated across multiple clearance sites within an individual. CONCLUSION: Plasma NT-proBNP is cleared by multiple tissues in the human circulation with approximately 55-65% of total clearance occurring in renal tissue. These data provide the first evidence for extra-glomerular clearance of NT-proBNP and suggest a common multisite clearance mechanism subject to generalized regulation. Renal NT-proBNP extraction was sustained in the face of even moderate levels of kidney dysfunction.
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Palmer et al. (2009) conducted an observational in Cardiovascular disorders (n=120). Plasma NT-proBNP clearance was evaluated on Site(s) of production and clearance of plasma NT-proBNP in the human circulation. Plasma NT-proBNP is cleared by multiple tissues, with 55-65% of total clearance occurring in the kidney, 20-25% in the liver, 10-15% in musculoskeletal tissue, and 5-10% in the head and neck.
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