N-terminal pro-brain natriuretic peptide is a useful prognostic marker in patients with pulmonary hypertension and renal insufficiency

Background : N-terminal pro-brain natriuretic peptide (NT-proBNP) is a routinely used prognostic parameter in patients with pulmonary hypertension (PH). As it accumulates in patients with renal insufficiency the clinical value of NT-proBNP in PH patients with renal insufficiency remains unclear. Methods : Ninety five PH patients (WHO class I and IV) with and without renal insufficiency (defined as glomerular filtration rate (GFR) ≤60 ml/min/1.73m2) were retrospectively matched regarding hemodynamic parameters. Correlations of NT-proBNP with demographic, hemodynamic and prognostic parameters (Time to clinical worsening, TTCW) were evaluated. Results : Patients with renal insufficiency (n=39, GFR 45±11) were older and showed shorter 6-minute walking distances than patients with normal renal function (n=56, GFR 78±13). GFR correlated inversely with NT-proBNP (r=-.35, p=.001). Overall, GFR was the strongest predictor of NT-proBNP in a multivariate regression model including hemodynamic parameters. In patients with renal insufficiency, NT-proBNP correlated with pulmonary vascular resistance, right atrial pressure and cardiac index (r>.35, p Conclusion : In a retrospective cohort study we showed that, although NT-proBNP levels are affected by renal function, this marker correlated with hemodynamic parameters and predicted clinical outcome in patients with renal insufficiency.