Key result
Elevated NT-proBNP levels >15,000 pg/mL were strongly associated with increased cardiovascular mortality in patients with end-stage kidney disease (HR 5.95; 95% CI 4.23-8.37).
Why the study?
Use of BNP and NT-proBNP for cardiovascular risk assessment in patients with end-stage kidney disease remains unclear.
Are elevated NT-proBNP and BNP levels associated with increased risk of cardiovascular and all-cause mortality in patients with ESKD?
Meta-Analysis (n=19,688)
Are elevated NT-proBNP and BNP levels associated with increased risk of cardiovascular and all-cause mortality in patients with ESKD?
Hazard Ratio: 5.95 (95% CI 4.23–8.37)
Elevated NT-proBNP and BNP levels are strongly associated with increased risk for cardiovascular and all-cause mortality in patients with ESKD, with higher thresholds indicating progressively greater risk.
Elevated BNP/NT-proBNP levels may refine CV risk stratification in ESKD; leaves open incremental value beyond standard clinical models.
RATIONALE & OBJECTIVE: Use of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) for cardiovascular (CV) risk assessment in patients with end-stage kidney disease (ESKD) remains unclear. We examined the associations between different threshold elevations of these peptide levels and clinical outcomes in patients with ESKD. STUDY DESIGN: Systematic review and meta-analysis. SETTING & STUDY POPULATIONS: or receiving maintenance dialysis). SELECTION CRITERIA FOR STUDIES: Studies that reported NT-proBNP or BNP levels and future CV events, CV mortality, or all-cause mortality. DATA EXTRACTION: Cohort characteristics and measures of risk associated with study-specified peptide thresholds. ANALYTICAL APPROACH: Hazard ratios (HRs) for clinical outcomes associated with different NT-proBNP and BNP ranges were categorized into common thresholds and pooled using random-effects meta-analysis. RESULTS: We identified 61 studies for inclusion in our review (19,688 people). 49 provided sufficient detail for inclusion in meta-analysis. Pooled unadjusted HRs for CV mortality were progressively greater for greater thresholds of NT-proBNP, from 1.45 (95% CI, 0.91-2.32) for levels>2,000pg/mL to 5.95 (95% CI, 4.23-8.37) for levels>15,000pg/mL. Risk for all-cause mortality was significantly higher at all NT-proBNP thresholds ranging from> 1,000 to> 20,000pg/mL (HR range, 1.53-4.00). BNP levels>550pg/mL were associated with increased risk for CV mortality (HR, 2.54; 95% CI, 1.49-4.33), while the risks for all-cause mortality were 2.04 (95% CI, 0.82-5.12) at BNP levels>100pg/mL and 2.97 (95% CI, 2.21-3.98) at BNP levels>550pg/mL. Adjusted analyses demonstrated similarly greater risks for CV and all-cause mortality with greater NT-proBNP concentrations. LIMITATIONS: Incomplete outcome reporting and risk for outcome reporting bias. Estimation of risk for CV events for specific thresholds of both peptides were limited by poor precision. CONCLUSIONS: ESKD-specific NT-proBNP and BNP level thresholds of elevation are associated with increased risk for CV and all-cause mortality. This information may help guide interpretation of NT-proBNP and BNP levels in patients with ESKD.
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Harrison et al. (2020) conducted a meta-analysis in End-stage kidney disease (ESKD) (n=19,688). Elevated NT-proBNP and BNP levels vs. Lower peptide levels was evaluated on Cardiovascular mortality (NT-proBNP >15,000 pg/mL threshold) (HR 5.95, 95% CI 4.23-8.37). Elevated NT-proBNP levels >15,000 pg/mL were strongly associated with increased cardiovascular mortality in patients with end-stage kidney disease (HR 5.95; 95% CI 4.23-8.37).
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