Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure
Background Natriuretic peptides have been recommended as biomarkers for the diagnosis and prognosis of patients with heart failure and are often elevated in the setting of acute kidney injury. We sought to demonstrate the associations between increased baseline NT‐proBNP (N‐terminal pro‐B‐type natri...
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031453 |
| _version_ | 1797400681724772352 |
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| author | Thanat Chaikijurajai Sevag Demirjian W. H. Wilson Tang |
| author_facet | Thanat Chaikijurajai Sevag Demirjian W. H. Wilson Tang |
| author_sort | Thanat Chaikijurajai |
| collection | DOAJ |
| description | Background Natriuretic peptides have been recommended as biomarkers for the diagnosis and prognosis of patients with heart failure and are often elevated in the setting of acute kidney injury. We sought to demonstrate the associations between increased baseline NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) and adverse renal outcomes in patients with moderate‐to‐severe acute kidney injury. Methods and Results We reviewed electronic medical records of consecutive patients with acute kidney injury stage 2 and 3 admitted to the Cleveland Clinic between September 2011 and December 2021. Patients with NT‐proBNP levels collected before renal consultation or dialysis initiation were included. Adverse renal outcomes included dialysis requirement and dialysis dependence defined as patients undergoing dialysis within 72 hours before hospital discharge or in‐hospital mortality. In our study cohort (n=3811), 2521 (66%) patients underwent dialysis, 1619 (42%) patients became dialysis dependent, and 1325 (35%) patients had in‐hospital mortality. After adjusting for cardiorenal risk factors, compared with the lowest quartile, the highest quartile of NT‐proBNP (≥18 215 pg/mL) was associated with increased likelihood of dialysis requirement (adjusted odds ratio [OR], 2.36 [95% CI, 1.87–2.99]), dialysis dependence (adjusted OR, 1.89 [95% CI, 2.53–1.34]), and in‐hospital mortality (adjusted OR, 1.34 [95% CI, 1.01–1.34]). Conclusions Increased NT‐proBNP was associated with an increased risk of dialysis requirement, becoming dialysis dependent, and in‐hospital mortality in patients with moderate‐to‐severe acute kidney injury. |
| first_indexed | 2024-03-09T01:58:59Z |
| format | Article |
| id | doaj.art-bf0769dcde294d9c9004e6b90fec4e14 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-09T01:58:59Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-bf0769dcde294d9c9004e6b90fec4e142023-12-08T11:09:10ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-11-01122110.1161/JAHA.123.031453Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart FailureThanat Chaikijurajai0Sevag Demirjian1W. H. Wilson Tang2Kaufman Center for Heart Failure Treatment and Recovery Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OHGlickman Urological and Kidney Institute, Cleveland Clinic Cleveland OHKaufman Center for Heart Failure Treatment and Recovery Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OHBackground Natriuretic peptides have been recommended as biomarkers for the diagnosis and prognosis of patients with heart failure and are often elevated in the setting of acute kidney injury. We sought to demonstrate the associations between increased baseline NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) and adverse renal outcomes in patients with moderate‐to‐severe acute kidney injury. Methods and Results We reviewed electronic medical records of consecutive patients with acute kidney injury stage 2 and 3 admitted to the Cleveland Clinic between September 2011 and December 2021. Patients with NT‐proBNP levels collected before renal consultation or dialysis initiation were included. Adverse renal outcomes included dialysis requirement and dialysis dependence defined as patients undergoing dialysis within 72 hours before hospital discharge or in‐hospital mortality. In our study cohort (n=3811), 2521 (66%) patients underwent dialysis, 1619 (42%) patients became dialysis dependent, and 1325 (35%) patients had in‐hospital mortality. After adjusting for cardiorenal risk factors, compared with the lowest quartile, the highest quartile of NT‐proBNP (≥18 215 pg/mL) was associated with increased likelihood of dialysis requirement (adjusted odds ratio [OR], 2.36 [95% CI, 1.87–2.99]), dialysis dependence (adjusted OR, 1.89 [95% CI, 2.53–1.34]), and in‐hospital mortality (adjusted OR, 1.34 [95% CI, 1.01–1.34]). Conclusions Increased NT‐proBNP was associated with an increased risk of dialysis requirement, becoming dialysis dependent, and in‐hospital mortality in patients with moderate‐to‐severe acute kidney injury.https://www.ahajournals.org/doi/10.1161/JAHA.123.031453acute kidney injurydialysismortalityNT‐proBNPrenal recovery |
| spellingShingle | Thanat Chaikijurajai Sevag Demirjian W. H. Wilson Tang Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute kidney injury dialysis mortality NT‐proBNP renal recovery |
| title | Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure |
| title_full | Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure |
| title_fullStr | Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure |
| title_full_unstemmed | Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure |
| title_short | Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure |
| title_sort | prognostic value of natriuretic peptide levels for adverse renal outcomes in patients with moderate to severe acute kidney injury with or without heart failure |
| topic | acute kidney injury dialysis mortality NT‐proBNP renal recovery |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031453 |
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