Koncentracije B-tipa natriuretskog peptida i N-terminalnog prohormon B-tipa natriuretskog peptida u krvi kao pokazatelji dijastolne funkcije leve komore kod bolesnika sa hroničnom bubrežnom insuficijencijom

  • Milica Petrović Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia.
  • Aleksandra Grdinić Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia.
  • Dubravko Bokonjić Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, National Poisoning Control Centre, Belgrade, Serbia.
  • Violeta Rabrenović Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
  • Svetlana Antić Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia.
  • Brankica Terzić Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia.
  • Dušica Stamenković Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Anesthesiology and Intensive Therapy, Belgrade, Serbia.
  • Zoran Stajić Institute for Health Protection of the Ministry of Interior, Department of Internal Medicine, Belgrade, Serbia.
  • Dejan Petrović University Clinical Center, Clinic of Urology and Nephrology, Kragujevac, Serbia.
  • Ljiljana Ignjatović Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia.
  • Janko Pejović Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Institute of Medical Biochemistry, Belgrade, Serbia.
  • Dragan Jovanović Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
DOI: https://doi.org/10.2298/VSP151019079P
Ključne reči: kidney failure, chronic||, ||bubreg, hronična insuficijencija, glomerular filtration rate||, ||glomerulska filtracija, ventricular function, left||, ||srce, funkcija leve komore, natriuretic peptides||, ||natriuretski peptidi, biological markers||, ||biološki pokazatelji, sensitivity and specificity||, ||senzitivnost i specifičnost,

Sažetak


Uvod/Cilj. Bolesnici sa hroničnom bubrežnom insuficijencijom (HBI) imaju povećan kardiovaskularni morbiditet i mortalitet. Nije poznato koji biomarkeri najbolje opisuju stepen dijastolne disfunkcije kod bolesnika sa HBI. Cilj ove studije bio je da se utvrdi povezanost koncentracije B-tipa natriuretskog peptida (BNP), N-terminalnog prohormon moždanog natriuretskog peptida (NTproBNP) i dijastolne disfunkcije leve komore (DD-LV) sa stepenom HBI. Metode. U studiju je bilo uključeno 100 odraslih bolesnika sa hroničnom bubrežnom bolesti koji nisu imali srčane i cerebralne incidente i nisu započeli aktivno lečenje HBI. Prema stepenu HBI bolesnike smo podelili u dve grupe: G1 (umereni stepen), glomerularna filtracija (GFR) ≥ 30 mL/min/1,73 m2, i G2 (teži stepen), GFR < 30 mL/min/1,73 m2. U krvi su određene koncentracije BNP i NTproBNP, a dopler ehokardiografskim merenjem procenjena je dijastolna disfunkcija leve komore (DD-LV). Prema stepenu DD-LV bolesnici su podeljeni u dve grupe: DD-LV1 (blaga dijastolna disfunkcija) i DD-LV2 (teška dijastolna disfunkcija). Prema stepenu HBI i DD-LV bolesnici su podeljeni u četiri grupe: I (G1, DD-LV1), II (G1, DD-LV2), III (G2, DD-LV1) i IV (G2, DD-LV2). Rezultati. Utvrđena je visokoznačajna statistička korelacija BNP i NTproBNP sa GFR (p < 0,001), a DD-LV sa BNP (p < 0,023), odnosno NTproBNP (p = 0,035). Registrovane su statistički značajno više koncentracije BNP kod bolesnika sa DD LV2, nego kod bolesnika sa G2 (p < 0,001). Za razliku od BNP, kod bolesnika sa disfunkcijom DD-LV1, ali i onih sa disfunkcijom DD-LV2, registrovane su statistički značajno veće koncentracije NTproBNP kod bolesnika sa G2 (DD-LV1: p = 0,006; DD-LV2: p < 0,001). Zaključak. Biomarkeri BNP i NTproBNP nisu najbolji prediktori u proceni dijastolne disfunkcije jer su u korelaciji sa stepenom hronične bubrežne insuficijencije.

 

Biografije autora

Milica Petrović, Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia.
Clinic of Nephrology
Aleksandra Grdinić, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia.
Clinic of Cardiology
Dubravko Bokonjić, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, National Poisoning Control Centre, Belgrade, Serbia.
Centre for Control of Poisoning
Violeta Rabrenović, Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Clinic of Nephrology
Svetlana Antić, Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia.
Clinic of Nephrology
Brankica Terzić, Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia.
Clinic of Nephrology
Dušica Stamenković, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Anesthesiology and Intensive Therapy, Belgrade, Serbia.
Clinic of Anesthesiology and Intensive Therapy
Zoran Stajić, Institute for Health Protection of the Ministry of Interior, Department of Internal Medicine, Belgrade, Serbia.
Department of Internal Medicine
Dejan Petrović, University Clinical Center, Clinic of Urology and Nephrology, Kragujevac, Serbia.
Clinic of Urology and Nephrology
Ljiljana Ignjatović, Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia.
Clinic of Nephrology
Janko Pejović, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Institute of Medical Biochemistry, Belgrade, Serbia.
Institute of Medical Biochemistry
Dragan Jovanović, Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Clinic of Nephrology

Reference

Magdalena L, Dorota F, Elzbieta P, Maria AW, Marek F. Chronic kidney disease- related atherosclerosis-proteomic studies of blood plasma. Proteome Sci 2011; 9: 25.

Levin A. Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial 2003; 16(2): 101−5.

Herzog CA, Asinger RW, Berger AK, Charytan DM, Díez J, Hart RG, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Out-comes (KDIGO). Kidney Int 2011; 80(6): 572−86.

Sidhu MS, Dellsperger KC. Cardivascular problems in dialysis pa-tients: Impact on Survival. Adv Perit Dial 2010; 26: 47−52.

Briasoulis A, Bakris GL. Chronic kidney disease as a coronary artery disease risk equivalent. Curr Cardiol Rep 2013; 15(3): 340.

Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascu-lar disease in chronic renal disease. J Am Soc Nephrol 1998; 9(12 Suppl): S16−23.

Verma A, Anavekar NS, Meris A, Thune JJ, Arnold MJ, Ghali JK, et al. The relationship between renal function and cardiac structure, function, and prognosis after myocardial infarction: the VALIANT Echo Study. J Am Coll Cardiol 2007; 50(13): 1238−45.

Otsuka T, Suzuki M, Yoshikawa H, Sugi K. Left ventricular dias-tolic dysfunction in the early stage of chronic kidney disease. J Cardiol 2009; 54(2): 199−204.

Shaha AM, Lamb CS, Chenga S, Vermaa A, Desaia AS, Rocha RA, et al. The relationship between renal impairment and left ventricular structure, function, and ventricular-arterial interac-tion in hypertension. J Hypertens 2011; 29(9): 1829−36.

Naidu SS, Selzer F, Jacobs A, Faxon D, Marks DS, Johnston J, et al. Renal insufficiency is an independent predictor of mortality after percutaneous coronary intervention. Am J Cardiol 2003; 92(10): 1160−4.

Manjunath G, Tighiouart H, Coresh J, Macleod B, Salem DN, Griffith JL, et al. Level of kidney function as a risk factor for cardi-ovascular outcomes in the elderly. Kidney Int 2003; 63(3): 1121−9.

Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Ex-amination Survey. Am J Kidney Dis 2003; 41(1): 1−12.

Lai S, Dimko M, Galani A, Coppola B, Innico G, Frassetti N, et al. Early markers of cardiovascular risk in chronic kidney disease. Ren Fail. 2015; 37(2): 254−61.

Fathi R, Isbel N, Haluska B, Case C, Johnson DW, Marwick TH. Correlates of subclinical left ventricular dysfunction in ESRD. Am J Kidney Dis 2003; 41(5): 1016−25.

Bruch C, Rothenburger M, Gotzmann M, Wichter T, Scheld HH, Brei-thardt G, et al. Chronic kidney disease in patients with chronic heart failure: Impact on intracardiac conduction, diastolic function and prognosis. Int J Cardiol 2007; 118(3): 375−80.

Harada M, Hara F, Yamazaki J. Correlation between plasma B-type natriuretic peptide levels and left ventricular diastolic function using color kinetic imaging. J Cardiol 2010; 56(1): 91−6.

Kim J, Kim SG, Kim M, Kim SE, Kim SJ, Kim HJ, et al. Left ven-tricular diastolic dysfunction as a predictor of rapid decline of residual renal function in patients with peritoneal dialysis. J Am Soc Echocardiogr 2012; 25(4): 411−20.

Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: A consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007; 28(20): 2539−50.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtra-tion rate. Ann Intern Med 2009; 50(9): 604−12.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treat-ment of High Blood Pressure: The JNC 7 report. JAMA 2003; 289(19): 2560−72.

Yang Y, Wang Y, Shi Z, Zhu D, Gao P. Association of E/E' and NT-proBNP with renal function in patients with essential hypertension. PLoS ONE 2013; 8(1): e54513.

Victor BM, Barron JT. Diastolic heart failure versus diastolic dysfunction: Difference in renal function. Clin Cardiol 2010; 33(12): 770−4.

Lubien E, DeMaria A, Krishnaswamy P, Clopton P, Koon J, Kazanegra R, et al. Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 2002; 105(5): 595−601.

Reddan DN, Szczech LA, Tuttle RH, Shaw LK, Jones RH, Schwab SJ, et al. Chronic kidney disease, mortality, and treatment strat-egies among patients with clinically significant coronary artery disease. J Am Soc Nephrol 2003; 14(9): 2373−80.

Muntner P, He J, Hamm L, Loria C, Whelton PK. Renal insuffi-ciency and subsequent death resulting from cardiovascular dis-ease in the United States. J Am Soc Nephrol 2002; 13(3): 745−53.

Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL, et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol 2003; 41(1): 47−55.

Objavljeno
2017/07/07
Broj časopisa
Vol. 74 Br. 6 (2017)
Rubrika
Originalni članak