Key result
A decreased change in NT-proBNP accompanying an episode of acute kidney injury was associated with a lower risk of 90-day mortality (adjusted HR 0.62) in elderly patients with chronic heart failure.
Why the study?
The relationship between kidney dysfunction and NT-proBNP levels regarding prognosis is complicated and has rarely been analyzed in elderly patients with CHF who develop AKI.
Do serum NT-proBNP levels and their changes predict survival and renal outcomes in elderly patients with acute kidney injury and chronic heart failure?
Cohort (n=1,160)
No
Do serum NT-proBNP levels and their changes predict survival and renal outcomes in elderly patients with acute kidney injury and chronic heart failure?
Hazard Ratio: 0.62 (95% CI 0.48–0.79)
p-value: p=<0.001
In elderly patients with chronic heart failure and acute kidney injury, a decrease in NT-proBNP during the AKI episode is associated with improved 90-day survival but an increased risk of non-recovery of renal function.
May support NT-proBNP trend monitoring during AKI in elderly HF; hypothesis-generating and should not yet change practice.
Background: Elderly patients exhibit a higher incidence of chronic heart failure (CHF). Patients with CHF can develop acute kidney injury (AKI) during follow-up, which can result in poor prognosis. This relationship between kidney dysfunction and levels of N-terminal pro-brain natriuretic peptides (NT-proBNP), with regard to prognosis, is complicated and has rarely been analyzed in elderly patients with CHF. Method: We conducted a retrospective cohort study involving patients with a CHF history aged ≥ 65 years, who experienced an episode of AKI. Kaplan-Meier curves and Cox or logistic proportional hazards regression models were used to evaluate the association between serum NT-proBNP concentrations and mortality or renal recovery by day 90. Results: A total of 1,160 eligible patients with AKI were available for the study. Of this sample, 41.5% of patients died within 90 days of the onset of AKI. Patients with a decreased change in NT-proBNP accompanying the episode of AKI had a lower risk (adjusted OR = 0.56, 95% CI = 0.34-0.91) of more severe AKI (stage 2 and 3 vs. stage 1). The more severe AKI were associated with higher mortality and non-recovery of renal function in elderly patients with CHF, independent of NT-proBNP levels. Elevated levels of baseline lnNT-proBNP (adjusted HR = 1.27, 95% CI = 1.17-1.38) predicted mortality in elderly patients with CHF within 90 days of AKI onset. Patients with a decrease in NT-proBNP accompanying AKI had a lower risk of mortality (adjusted HR = 0.62, 95% CI = 0.48-0.79). However, a decrease in NT-proBNP is a risk factor (adjusted OR = 1.59, 95% CI = 1.02-2.48) for the non-recovery of renal function following AKI-especially in elderly survivors with low baseline NT-proBNP levels. Conclusion: A decreased change in NT-proBNP maybe protective for elderly patients with CHF by improving survival outcomes and preventing severe AKI. However, an excessive decrease in NT-proBNP is a risk factor for the non-recovery of renal function following AKI. Avoiding excessive changes in NT-proBNP may be protective for survival and renal injury prognosis.
No takes yet. Share an insight, caveat, or question.
Hou et al. (2023) conducted a cohort in Acute kidney injury in chronic heart failure (n=1,160). Decreased change in NT-proBNP vs. Increased or unchanged NT-proBNP was evaluated on 90-day mortality (HR 0.62, 95% CI 0.48-0.79, p=<0.001). A decreased change in NT-proBNP accompanying an episode of acute kidney injury was associated with a lower risk of 90-day mortality (adjusted HR 0.62) in elderly patients with chronic heart failure.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: