Abstract 5947: Impact of LV End-diastolic Wall Stress on Plasma BNP Levels in Heart Failure with Chronic Kidney Disease and End-Stage Renal Disease
Plasma B-type natriuretic peptide (BNP) is a diagnostic and prognostic marker in heart failure (HF). We have reported that plasma BNP level strongly reflects LV end-diastolic wall stress (EDWS) in HF patients with normal renal function. Although renal function is reported as one of the important clinical determinants for BNP, precious evaluations in terms of the relationship with hemodynamic factors and renal function have not been performed. Therefore, we evaluated the association of plasma BNP levels with LV EDWS in a broad range of HF patients including those with CKD and ESRD. 156 patients with HF including CKD and ESRD were enrolled in the present study. Plasma BNP was measured and echocardiography and cardiac catheterization were performed. LV EDWS was calculated as a crucial hemodynamic determinant of BNP. Plasma BNP levels increased progressively across the groups by renal function (p < 0.01). They were well-correlated with LV EDWS (r = 0.47, P<0.01) in the overall HF patients (Figure⇓ left). Plasma BNP levels increased progressively along with the grade of EDWS both in the Normal and CKD groups. Patients with ESRD and high EDWS showed the highest plasma BNP level (Figure⇓ right). In a multivariable analysis, higher EDWS was associated with increased BNP level independent of renal dysfunction (P<0.05). Anemia, systolic HF, and decreased BMI also contributed to increased BNP levels. These results suggest that LV EDWS is an important determinant of BNP even in patients with CKD and ESRD. BNP is expected to have high prognostic values as an integrated marker of cardio-renal function and anemia.