The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost?

Q: What is the clinical evidence from this study?

Study design: Observational. Population: End-stage renal disease on hemodialysis (ESRD on HD) presenting with acute dyspnea (n=250). Intervention: Elevated NT-ProBNP test vs. Normal NT-ProBNP test or no NT-ProBNP test performed. Primary outcome: Left ventricular ejection fraction (LVEF, %) (p=0.43).

Q: What does this research mean for the field?

NT-ProBNP testing has no clinical utility in identifying the etiology of acute dyspnea in end-stage renal disease patients on hemodialysis and does not correlate with left ventricular ejection fraction or fluid removal. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shaffer Mok; J. M. Reyes Ávila; Barry Milcarek; Richard Kasama

doi:10.1155/2013/836497

January 1, 2013Emergency Medicine InternationalOpen Access

The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost?

View Full Paper

Ask AI

Bookmark

Share

Key result

NT-ProBNP levels show no correlation with LVEF or fluid removal in hemodialysis patients with acute dyspnea.

P=0.43
n=250

Why the study?

Does NT-ProBNP testing have clinical utility in determining the etiology of acute dyspnea or guiding management in patients with end-stage renal disease on hemodialysis?

Key Points

To assess the clinical utility of the NT-ProBNP test in identifying the cause of acute dyspnea in patients with end-stage renal disease undergoing hemodialysis.
Retrospective case series of 250 patients with end-stage renal disease on hemodialysis admitted with acute dyspnea to Cooper University Hospital between 07/2010 and 03/2011.
Evaluated the frequency of cardiology consultations, echocardiography, and elevated versus normal NT-ProBNP levels.
Calculated correlation coefficients between NT-ProBNP levels and age, estimated dry weight, fluid removed, and echocardiographic parameters.
Among 235 patients tested, NT-ProBNP levels did not correlate with age (r = 0.05), baseline estimated dry weight (r = -0.09), volume of fluid removed (r = 0.07), or ejection fraction (r = 0.02).
Cardiology consults occurred in 68.8% of patients and 58% underwent echocardiography, with estimated mean ejection fractions of 54.6% in the elevated group, 50.8% in the normal group, and 61.7% in the untested group.
No differences were detected across other standard echocardiographic parameters between groups with elevated, normal, or unmeasured NT-ProBNP.

Study Design

Type

Observational (n=250)

Multicenter

No

Structured PICO

Does NT-ProBNP testing have clinical utility in determining the etiology of acute dyspnea or guiding management in patients with end-stage renal disease on hemodialysis?

P

Population

250 adults aged >=18 years with end-stage renal disease on hemodialysis admitted to a US hospital with acute dyspnea between July 2010 and March 2011.

E

Exposure

NT-ProBNP testing (measured by electro-chemiluminescence immunoassay; categorized as elevated for age vs. normal for age, and further analyzed by lowest quartile ≤5676 pg/mL vs. highest quartile ≥32499 pg/mL)

C

Comparator

Normal NT-ProBNP for age or no NT-ProBNP test performed

O

Outcome

Clinical and diagnostic utility parameters including correlation and subgroup differences in left ventricular ejection fraction (EF in %), estimated dry weight (EDW in kg), amount of postdialysis fluid removed (L), echocardiography ordering, and cardiology consultationsurrogate

Main Result

Absolute Event Rate: 54.6% vs 50.8%

p-value: p=0.43

In patients with ESRD on hemodialysis presenting with acute dyspnea, NT-ProBNP is almost universally elevated (97.9%) and shows no correlation with ejection fraction or volume removed, indicating no clinical utility for differentiating the etiology of dyspnea in this population.

Limitations

Lack of data on subjects receiving a BNP test
Retrospective data collection
Does not take into account individual cases, but rather trends in the sample population
Single-center study
Analysis focused on population trends rather than individual cases

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

NT-ProBNP should not guide dyspnea etiology assessment in ESRD on hemodialysis; leaves open need for prospective studies of alternative markers.

Abstract

Background. The NT-ProBNP/BNP test has been validated as a marker for determining the etiology of acute dyspnea. In the setting of end-stage renal disease on hemodialysis (ESRD on HD), the utility of the NT-ProBNP/BNP test has not been validated. This study examines the clinical utility of the NT-ProBNP test in the setting of ESRD on HD patients presenting with acute dyspnea. Methods. A retrospective case series of 250 subjects were admitted to Cooper University Hospital, 07/2010-03/2011, with ESRD and HD presenting with dyspnea. The incidences of echocardiography, cardiology consultation, and NT-ProBNP elevated and normal were examined. Correlation coefficients were calculated for NT-ProBNP with age (years), estimated dry weight (kg), amount of fluid removed (L), and ejection fraction (EF in %) among other echocardiography parameters. Results. Of the total sample 235 patients had NT-ProBNP levels performed. Cardiology consults were placed in 68.8% and 58% who underwent echocardiography. Of those for whom an echocardiography was performed estimated mean EFs of 54.6%, 50.8%, and 61.7% were observed among the NT-ProBNP elevated group, normal group, and no NT-ProBNP group, respectively. No differences were detected in all other echocardiography measurements. No correlation was observed between NT-ProBNP and age (r = 0.05), baseline EDW (r = -0.09), amount of fluid removed (r = 0.07), or EF (r = 0.02). Conclusion. In the setting of ESRD on HD, the NT-ProBNP test has no clinical utility in determining the etiology of acute dyspnea. This can be demonstrated through echocardiographic and therapeutic parameters measured in this study.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Mok et al. (2013) conducted an observational in End-stage renal disease on hemodialysis (ESRD on HD) presenting with acute dyspnea (n=250). Elevated NT-ProBNP test vs. Normal NT-ProBNP test or no NT-ProBNP test performed was evaluated on Left ventricular ejection fraction (LVEF, %) (p=0.43). NT-ProBNP testing in ESRD patients on hemodialysis with acute dyspnea showed no correlation with LVEF (r = 0.02) or fluid removed (r = 0.07), and mean EF did not differ between elevated and normal groups (54.6% vs 50.8%, p = 0.43).

synapsesocial.com/papers/6a8300fad1e5557f1151a8b2 https://doi.org/10.1155/2013/836497

View Full Paper

Ask AI

Bookmark

Share

The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading