Brain natriuretic peptide is related to carotid plaques and predicts atherosclerosis in pre-dialysis patients with chronic kidney disease

BackgroundAlthough brain natriuretic peptide (BNP) concentration has been associated with atherosclerosis and ischemic cardiovascular diseases (CVD) in the general population, less is known about this relationship in pre-dialysis chronic kidney disease (CKD) patients.MethodsWe prospectively analyzed 227 pre-dialysis patients with CKD [median estimated glomerular filtration rate (eGFR): 28.82 (11.65–48.20) ml/min/1.73 m2]. At enrollment, BNP concentrations, biochemical and echocardiographic parameters were measured, and carotid artery ultrasound was performed. Patients were prospectively followed for a mean 31.8 months (range 0.5–57.0 months). Ischemic CV events and patient outcomes were recorded.ResultsMedian BNP concentration at enrollment was significantly higher in the CKD patients than in a control group [53.9 (16.2–181.0) pg/ml vs. 9.4 (7.0–15.3) pg/ml, P < 0.01]. BNP concentration was positively related with the carotid intima–media thickness of the common carotid artery (CCA-IMT) and left ventricular mass index (LVMI) and was significantly higher in patients with than without carotid plaques (P < 0.01). Logistic regression analysis confirmed that lgBNP concentration was independently correlated with carotid plaques. Thirty-two patients experienced ischemic cardiovascular (ICV) events during follow-up. Kaplan–Meier analysis showed that cumulative survival without new ICV events was better in patients with lower than with higher BNP concentrations (P < 0.01). Cox regression analysis showed that BNP was an independent risk factor for ICV events (HR = 3.167, 95%CI = 1.398–7.171, P < 0.01).ConclusionsSimilar to findings in the general population, elevated BNP level is related to atherosclerosis and an increased risk of ICV events in pre-dialytic CKD patients.