B-type natriuretic peptide is not a prognostic marker in acute dyspneic patients with renal insufficiency

Objective: The prognostic value of BNP levels in patients presenting with acute dyspnea and renal insufficiency (RI) has been questioned. We evaluated the long-term prognostic value of BNP levels in dyspneic patients with RI. Methods: Of 1,207 consecutive participants who presented with acute dyspnea, patients with mild-to-severe RI (15<eGFR<90mL/min/1.73m²) were recruited. During follow-up, major adverse events (MAEs), i.e., all causes of death and rehospitalization, because of worsening heart failure were evaluated. Results: A total of 408 patients with acute dyspnea and RI were evaluated. During a 30.1± 31.7-month follow-up, cardiac death (n=26), non-cardiac death (n=28) and hospital re-admission (n=117) was observed in 35% of patients (n=143). The adjusted multiple Cox regression analysis showed that left atrial diameter was a significant prognostic maker of MAEs (relative risk, 1.18; 95% confidence interval, 1.03-1.34; p=0.02). Conclusions: We focused on subjects with acute dyspnea and renal failure who required hospital admission, BNP level was not a prognostic marker but left atrial diameter as a surrogate marker of diastolic dysfunction was an independent prognostic maker of all cause of death and rehospitalization due to aggravated heart failure.