Use of B-type natriuretic peptide in the prediction of renal and cardiovascular outcomes after percutaneous revascularization in patients with renal artery stenosis

Introduction: Controversial data were gathered in the literature concerning the use of B-type natriuretic peptide (BNP) in the prediction of renal function preservation and blood pressure (BP) control after renal revascularization. Recently, the marker’s predictive value in assessing the morbimortality in renal artery stenosis (RAS) patients was suggested.
Objective: The current analyses aimed to evaluate the role of BNP in the prediction of primary (renal function improvement, blood pressure control) and secondary (severe renal complications and major adverse cardiac events – MACE) clinical outcomes after revascularization in selected hypertensive patients with significant RAS.
Methods: There were prospectively enrolled 78 hyper-tensive patients diagnosed with significant uni- and bilateral RAS, subsequently resulting in 3 groups (34-unilateral, 28-bilateral RAS and 16-RAS in solitary kidney). Clinical, biological and echocardiographic parameters were comparatively evaluated between groups at admission and 12 months’ after renal stenting. Renal function’ and BP evolution after stenting were evaluated at 12 months. Secondary outcomes were assessed after a mean follow-up period of 24.27±12.16 months. Regression logistic analysis – univariate and multivariate (stepwise Likelihood ratio method) was used in order to define the independent predictors for major outcomes.
Results: BNP and lnBNP (logarithmic value of cor-responding BNP) did not correlate with the evolution of BP or renal function improvement after revas-cularization. Multivariate logistic regression analysis confirmed baseline lnBNP as an unique independent predictor for major renal events (area under the receiver-operating characteristics curve was 0.95 – 95% CI, 0.83-1.01, p=0.002). The same analysis for MACE pre-diction confirmed 5 independent predictors assessed 12 month’ after stenting: BP non-responder, lnBNP level, left ventricular (LV) dysfunction, antiplatelet therapy and smoking. The accuracy of the model was 86.8%, while lnBNP alone as an unique predictor of MACE, provided 76.3% of the accuracy of the multi-parametric model.
Conclusions: The present findings demonstrated that BNP either as numerical or logarithmic value is not a reliable predictor for one-year outcomes (renal function improvement and blood pressure control) after revascularization, but could be a valuable biomarker in the assessment of major adverse renal events and MACE. Larger sample size may be considered for clinical relevance of BNP in RAS patients.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)