Longitudinal B-type natriuretic peptide monitoring and kidney failure
Fluid management is one of the major challenges in treating people with chronic kidney disease (CKD). Volume overload can lead to symptoms of acute heart failure (HF) and may increase the risk of CKD progression, while hypovolaemia may predispose to acute kidney injury (AKI). Optimal fluid management may, therefore, improve kidney outcomes in individuals with CKD not on dialysis.
Plasma B-type natriuretic peptide (BNP) is an easily measurable and objective biomarker that reflects volume status in HF and non-dialysis CKD. Although it can aid decision-making about the optimisation of volume status, its clinical benefit remains uncertain in CKD.
The present retrospective cohort study evaluated the association between BNP monitoring and risk of incident kidney replacement therapy (KRT) in adults with CKD. Data from 2998 outpatients (baseline median age, 66 years; eGFR, 38.1 mL/min/1.73 m2) with non-dialysed CKD (stages 3–5) at a Japanese hospital were analysed.
During follow-up (median [IQR], 5.9 years), 449 started KRT, 765 had AKI, 236 were hospitalised for HF and 271 died. After adjustment for time-updated clinical characteristics of patients and physician-specific practice style, BNP monitoring in this cohort was found to be associated with lower risks of KRT initiation (HR, 0.44 [95% CI, 0.21–0.92]), AKI (HR, 0.36 [0.18–0.72] and HF hospitalisation (HR, 0.37 [0.14–0.95]), all of which are major adverse outcomes of CKD. Further analysis of the data suggested that the better kidney prognosis associated with BNP monitoring was potentially mediated through a reduced risk of AKI or HF hospitalisation.
Despite acknowledging some limitations of the study, the authors conclude that monitoring plasma BNP longitudinally can aid physicians to provide optimal fluid management. Further research is required to determine whether BNP-guided therapy decreases the risk of kidney failure requiring replacement therapy in people with CKD.
The full article can be read here.
