NT-proBNP predicts sudden death, stroke in diabetes with renal disease

5 September 2008

MedWire News: Elevated N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is a potent risk factor for sudden death and stroke in patients with Type 2 diabetes on hemodialysis, and may guide future treatment strategies, according to data from the German Diabetes and Dialysis Study (GDDS).

Reporting their findings in the European Heart Journal, Karl Winkler (University Medical Center, Freiburg, Germany) and colleagues say this is the first time that the impact of NT-pro-BNP of these particular cardiovascular (CV) events has been evaluated in renal patients.

GDDS involved a 4-year follow-up of 1255 diabetes patients on maintenance hemodialysis treatment who were randomized to treatment with atorvastatin or placebo.
Sudden death occurred in 160 patients, stroke in 99 patients, myocardial infarction (MI) in 200 patients, CV events (cardiac death, MI, and stroke) in 465 patients, and all-cause mortality in a further 612 patients.

Patients with high baseline NT-pro-BNP (≥9252pg/ml) had a greater than four-fold increase in the risk for stroke and a two-fold increased risk for sudden death, CV events, and mortality compared with patients with a low baseline NT-pro-BNP (≤1422pg/ml).

Subsequent changes in NT-pro-BNP were strongly associated with sudden death, cardiovascular events, and mortality. Doubling of NT-pro-BNP increased the risk for death by 46%, although neither baseline nor change in NT-pro-BNP significantly increased the risk for MI.

Winkler and co-authors conclude: "NT-pro-BNP is an important risk factor for death and CV events in patients with Type 2 diabetes on maintenance hemodialysis treatment.

"Not only high baseline NT-pro-BNP, but also increases in NT-pro-BNP over time, are associated with poor long-term clinical outcomes."

They add: "Whether treatment strategies guided by NT-pro-BNP levels will decrease morbidity and mortality needs to be evaluated in future."

Eur Heart J 2008; 29: 2092-99