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DOI: 10.1055/a-0603-3792
Relationship Between the Brain Natriuretic Peptide (BNP) Level and Prognosis of Diabetic Nephropathy with Microalbuminuria: A 7-Year Follow-Up Study
Publikationsverlauf
received 28. Juli 2017
accepted 05. April 2018
Publikationsdatum:
03. Mai 2018 (online)
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Abstract
The aim of the study was to examine the relationship between the brain natriuretic peptide (BNP) level and prognosis of diabetic nephropathy. The subjects were 100 Japanese outpatients with type 2 diabetes mellitus with microalbuminuria. Associations between metabolic parameters at baseline, including BNP, and prognosis of diabetic nephropathy (progression of diabetic nephropathy, cardiovascular events, and death) were examined for 7 years. In Cox proportional hazard analysis, HbA1c, albumin-creatinine ratio (ACR) and BNP were identified as significant factors for progression of diabetic nephropathy (p=0.033, p=0.037, and p=0.044, respectively), BNP was identified as significant factor for cardiovascular events (p=0.046), and estimated glomerular filtration rate (eGFR) and BNP were identified as significant factors for death (p=0.046 and p=0.048, respectively). In Kaplan–Meier analysis, risks of progression of diabetic nephropathy, cardiovascular events, and death were significantly different between patients with a low and a high BNP level (p=0.046, p=0.002, and p=0.025, respectively). ROC curve analysis gave cutoff values for BNP of 14.9 pg/ml for progression of diabetic nephropathy, 16.3 pg/ml for cardiovascular events, and 17.6 pg/ml for death (p=0.047, p=0.035, p=0.018, respectively). In conclusion, the BNP level is associated with prognosis in diabetic nephropathy.
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References
- 1 Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-1305
- 2 Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003; 63: 225-232
- 3 Karnib HH, Ziyadeh FN. The cardiorenal syndrome in diabetes mellitus. Diabetes Res Clin Pract 2010; 89: 201-208
- 4 Ronco C, McCullough P, Anker S, Anand I, Aspromonte N, Bagshaw S, Bellomo R, Berl T, Bobek I, Cruz D, Daliento L, Davenport A, Haapio M, Hillege H, House A, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P. Cardio-renal syndromes: Report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 2010; 31: 703-711
- 5 Toyoda K. Cerebrorenal interaction and stroke. Contrib Nephrol 2013; 179: 1-6
- 6 Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Omland T, Wolf PA, Vasan RS. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 2004; 350: 655-663
- 7 Takahashi T, Nakamura M, Onoda T, Ohsawa M, Tanno K, Itai K, Sakata K, Sakuma M, Tanaka F, Makita S, Yoshida Y, Ogawa A, Kawamura K, Okayama A. Predictive value of plasma B-type natriuretic peptide for ischemic stroke: A community-based longitudinal study. Atherosclerosis 2009; 207: 298-303
- 8 Bhalla MA, Chiang A, Epshteyn VA, Kazanegra R, Bhalla V, Clopton P, Krishnaswamy P, Morrison LK, Chiu A, Gardetto N, Mudaliar S, Edelman SV, Henry RR, Maisel AS. Prognostic role of B-type natriuretic peptide levels in patients with type 2 diabetes mellitus. J Am Coll Cardiol 2004; 44: 1047-1052
- 9 Goto T, Takase H, Toriyama T, Sugiura T, Kurita Y, Tsuru N, Masuda H, Hayashi K, Ueda R, Dohi Y. Increased circulating levels of natriuretic peptides predict future cardiac event in patients with chronic hemodialysis. Nephron 2002; 92: 610-615
- 10 Spanaus KS, Kronenberg F, Ritz E, Schlapbach R, Fliser D, Hersberger M, Kollerits B, Konig P, von Eckardstein A. B-type natriuretic peptide concentrations predict the progression of nondiabetic chronic kidney disease: The Mild-to-Moderate Kidney Disease Study. Clin Chem 2007; 53: 1264-1272
- 11 Fox CS, Gona P, Larson MG, Selhub J, Tofler G, Hwang SJ, Meigs JB, Levy D, Wang TJ, Jacques PF, Benjamin EJ, Vasan RS. A multi-marker approach to predict incident CKD and microalbuminuria. J Am Soc Nephrol 2010; 21: 2143-2149
- 12 Yasuda K, Kimura T, Sasaki K, Obi Y, Iio K, Yamato M, Rakugi H, Isaka Y, Hayashi T. Plasma B-type natriuretic peptide level predicts kidney prognosis in patients with predialysis chronic kidney disease. Nephrol Dial Transplant 27: 3885-3891
- 13 Yano Y, Katsuki A, Gabazza EC, Ito K, Fujii M, Furuta M, Tuchihashi K, Goto H, Nakatani K, Hori Y, Sumida Y, Adachi Y. Plasma brain natriuretic peptide levels in normotensive noninsulin-dependent diabetic patients with microalbuminuria. J Clin Endocrinol Metab 1999; 84: 2353-2356
- 14 Group UPDSU. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-853
- 15 Group UPDSU . Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703-713
- 16 Gaede P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet 1999; 353: 617-622
- 17 Araki S, Haneda M, Sugimoto T, Isono M, Isshiki K, Kashiwagi A, Koya D. Factors associated with frequent remission of microalbuminuria in patients with type 2 diabetes. Diabetes 2005; 54: 2983-2987
- 18 Gaede P, Tarnow L, Vedel P, Parving HH, Pedersen O. Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria. Nephrol Dial Transplant 2004; 19: 2784-2788
- 19 Seki N, Nishimura M, Matsumoto T, Fukazawa M, Kenmochi T. Relationship between BNP level and renal function in diabetic nephropathy with microalbuminuria. J Diabetes Complicat 2013; 27: 92-97
- 20 Seki N, Matsumoto T, Fukazawa M. Relationship between the brain natriuretic peptide (BNP) level and remission of diabetic nephropathy with microalbuminuria: A 3-year follow-up study. Horm Metab Res 2015; 47: 138-144
- 21 Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, Araki E, Ito C, Inagaki N, Iwamoto Y, Kasuga M, Hanafusa T, Haneda M, Ueki K. Report of the Committee on the classification and diagnostic criteria of diabetes mellitus. Diabetol Int 2010; 1: 2-20
- 22 Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161-167
- 23 Fischer Y, Filzmaier K, Stiegler H, Graf J, Fuhs S, Franke A, Janssens U, Gressner AM. Evaluation of a new, rapid bedside test for quantitative determination of B-type natriuretic peptide. Clin Chem 2001; 47: 591-594
- 24 Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009; 53: 982-992
- 25 Hanefeld M, Appelt D, Engelmann K, Sandner D, Bornstein SR, Ganz X, Henkel E, Haase R, Birkenfeld AL. Serum and Plasma Levels of Vascular Endothelial Growth Factors in Relation to Quality of Glucose Control, Biomarkers of Inflammation, and Diabetic Nephropathy. Horm Metab Res 2016; 48: 529-534
- 26 Onodera M, Nakamura M, Tanaka F, Takahashi T, Makita S, Ishisone T, Ishibashi Y, Itai K, Onoda T, Ohsawa M, Tanno K, Sakata K, Omama S, Ogasawara K, Ogawa A, Kuribayashi T, Sakamaki K, Okayama A. Plasma B-type natriuretic peptide is useful for cardiovascular risk assessment in community-based diabetes subjects: Comparison with albuminuria. Int Heart J 2012; 53: 176-181
- 27 Makino H, Mukoyama M, Mori K, Suganami T, Kasahara M, Yahata K, Nagae T, Yokoi H, Sawai K, Ogawa Y, Suga S, Yoshimasa Y, Sugawara A, Tanaka I, Nakao K. Transgenic overexpression of brain natriuretic peptide prevents the progression of diabetic nephropathy in mice. Diabetologia 2006; 49: 2514-2524
- 28 Kasahara M, Mukoyama M, Sugawara A, Makino H, Suganami T, Ogawa Y, Nakagawa M, Yahata K, Goto M, Ishibashi R, Tamura N, Tanaka I, Nakao K. Ameliorated glomerular injury in mice overexpressing brain natriuretic peptide with renal ablation. J Am Soc Nephrol 2000; 11: 1691-1701
- 29 Jerums G, Premaratne E, Panagiotopoulos S, MacIsaac R. The clinical significance of hyperfiltration in diabetes. Diabetologia 2010; 53: 2093-2104
- 30 Moore KB, McKenna K, Osman M, Tormey WP, McDonald D, Thompson CJ. Atrial natriuretic peptide increases urinary albumin excretion in people with normoalbuminuric type-2 diabetes. Ir J Med Sci 2007; 176: 67-73
- 31 Zhang PL, Mackenzie HS, Troy JL, Brenner BM. Effects of an atrial natriuretic peptide receptor antagonist on glomerular hyperfiltration in diabetic rats. J Am Soc Nephrol 1994; 4: 1564-1570
- 32 Sakamoto K, Kikkawa R, Haneda M, Shigeta Y. Prevention of glomerular hyperfiltration in rats with streptozotocin-induced diabetes by an atrial natriuretic peptide receptor antagonist. Diabetologia 1995; 38: 536-542