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Value of N-terminal brain natriuretic peptide as a prognostic marker in patients with CKD: results from the CREATE study

Locatelli, Francesco; Eckardt, Kai-Uwe; Macdougall, Iain C.; Tsakiris, Dimitrios; Clyne, Naomi LU ; Burger, Hans-Ulrich; Scherhag, Armin and Drueeke, Tilman B. (2010) In Current Medical Research and Opinion 26(11). p.2543-2552
Abstract
Background and objectives: This study assessed plasma N-terminal prohormone brain natriuretic peptide (NT-proBNP) as a prognostic marker of cardiovascular risk in patients with chronic kidney disease stages 3-4 and anaemia treated with epoetin beta to two haemoglobin target ranges. Design, setting, participants & measurements: Of 603 patients enrolled in the C ardiovascular Risk Reduction by Early Anaemia Treatment with Epoetin Beta (CREATE) trial (baseline creatinine clearance 15-35 mL/min; haemoglobin 11.0-12.5 g/dL), 291 were included in this sub-study. Patients received subcutaneous epoetin beta either immediately after randomisation (target 13.0-15.0 g/dL; Group 1), or after their haemoglobin levels had fallen < 10.5 g/dL... (More)
Background and objectives: This study assessed plasma N-terminal prohormone brain natriuretic peptide (NT-proBNP) as a prognostic marker of cardiovascular risk in patients with chronic kidney disease stages 3-4 and anaemia treated with epoetin beta to two haemoglobin target ranges. Design, setting, participants & measurements: Of 603 patients enrolled in the C ardiovascular Risk Reduction by Early Anaemia Treatment with Epoetin Beta (CREATE) trial (baseline creatinine clearance 15-35 mL/min; haemoglobin 11.0-12.5 g/dL), 291 were included in this sub-study. Patients received subcutaneous epoetin beta either immediately after randomisation (target 13.0-15.0 g/dL; Group 1), or after their haemoglobin levels had fallen < 10.5 g/dL (target 10.5-11.5 g/dL; Group 2). Chronic heart failure New York Heart Association class III-IV was an exclusion criterion. (ClinicalTrials.gov Identifier: NCT00321919) Results: Cardiovascular event rates were higher in patients with baseline NT-proBNP > 400 vs. 400 pg/mL (39 vs. 13 events; p = 0.0002). Dialysis was initiated in 68 vs. 42 patients with NT-proBNP > 400 vs. 400 pg/mL (p = 0.0003). Amongst patients with NT-proBNP > 400 pg/mL, there was no significant difference between treatment groups in risk of cardiovascular events (HR = 0.57; p = 0.08) or time to dialysis (HR = 0.65; p = 0.08). The overall interpretation of this substudy is, however, limited by its relatively small sample size which, together with low clinical event rates, result in a lack of statistical power for some analyses and should be viewed as being hypothesis-generating in nature. Conclusions: In chronic kidney disease patients with mild-to-moderate anaemia, elevated baseline plasma NT-proBNP levels are associated with a higher risk of cardiovascular events and an accelerated progression towards end-stage renal disease. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Current Medical Research and Opinion
volume
26
issue
11
pages
2543 - 2552
publisher
LibraPharm
external identifiers
  • wos:000283153900004
  • scopus:77958123335
ISSN
1473-4877
DOI
10.1185/03007995.2010.516237
language
English
LU publication?
yes
id
afafac1d-b9fe-416c-bcd5-cd42a40de65a (old id 1720979)
date added to LUP
2010-12-03 13:10:03
date last changed
2018-05-29 09:24:54
@article{afafac1d-b9fe-416c-bcd5-cd42a40de65a,
  abstract     = {Background and objectives: This study assessed plasma N-terminal prohormone brain natriuretic peptide (NT-proBNP) as a prognostic marker of cardiovascular risk in patients with chronic kidney disease stages 3-4 and anaemia treated with epoetin beta to two haemoglobin target ranges. Design, setting, participants &amp; measurements: Of 603 patients enrolled in the C ardiovascular Risk Reduction by Early Anaemia Treatment with Epoetin Beta (CREATE) trial (baseline creatinine clearance 15-35 mL/min; haemoglobin 11.0-12.5 g/dL), 291 were included in this sub-study. Patients received subcutaneous epoetin beta either immediately after randomisation (target 13.0-15.0 g/dL; Group 1), or after their haemoglobin levels had fallen &lt; 10.5 g/dL (target 10.5-11.5 g/dL; Group 2). Chronic heart failure New York Heart Association class III-IV was an exclusion criterion. (ClinicalTrials.gov Identifier: NCT00321919) Results: Cardiovascular event rates were higher in patients with baseline NT-proBNP &gt; 400 vs. 400 pg/mL (39 vs. 13 events; p = 0.0002). Dialysis was initiated in 68 vs. 42 patients with NT-proBNP &gt; 400 vs. 400 pg/mL (p = 0.0003). Amongst patients with NT-proBNP &gt; 400 pg/mL, there was no significant difference between treatment groups in risk of cardiovascular events (HR = 0.57; p = 0.08) or time to dialysis (HR = 0.65; p = 0.08). The overall interpretation of this substudy is, however, limited by its relatively small sample size which, together with low clinical event rates, result in a lack of statistical power for some analyses and should be viewed as being hypothesis-generating in nature. Conclusions: In chronic kidney disease patients with mild-to-moderate anaemia, elevated baseline plasma NT-proBNP levels are associated with a higher risk of cardiovascular events and an accelerated progression towards end-stage renal disease.},
  author       = {Locatelli, Francesco and Eckardt, Kai-Uwe and Macdougall, Iain C. and Tsakiris, Dimitrios and Clyne, Naomi and Burger, Hans-Ulrich and Scherhag, Armin and Drueeke, Tilman B.},
  issn         = {1473-4877},
  language     = {eng},
  number       = {11},
  pages        = {2543--2552},
  publisher    = {LibraPharm},
  series       = {Current Medical Research and Opinion},
  title        = {Value of N-terminal brain natriuretic peptide as a prognostic marker in patients with CKD: results from the CREATE study},
  url          = {http://dx.doi.org/10.1185/03007995.2010.516237},
  volume       = {26},
  year         = {2010},
}