Value of N-terminal brain natriuretic peptide as a prognostic marker in patients with CKD: results from the CREATE study
Value of N-terminal brain natriuretic peptide as a prognostic marker in patients with CKD: results from the CREATE study
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DOI：
10.1185/03007995.2010.516237
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发表时间：
2010-11-01
影响因子：
2.3
通讯作者：
Drueeke, Tilman B.
中科院分区：
文献类型：
--
作者：
Locatelli, Francesco;Eckardt, Kai-Uwe;Drueeke, Tilman B.
背景和目标：本研究评估了血浆N-末端脑钠肽前体（NT-proBNP）作为慢性肾脏疾病3-4期和贫血患者心血管风险的预后标志物，用依泊苷β治疗至两个血红蛋白目标范围。在603例入组Epoplatin Beta早期贫血治疗降低心血管风险（CREATE）试验的患者中，（基线肌酐清除率15-35 mL/min;血红蛋白11.0-12.5 g/dL），291例患者被纳入该子研究。患者在随机化后立即（目标13.0-15.0 g/dL;第1组）或在其血红蛋白水平下降< 10.5 g/dL（目标10.5-11.5 g/dL;第2组）后接受皮下注射epo 3 β。慢性心力衰竭纽约心脏协会III-IV级是排除标准。（临床试验政府标识符：NCT 00321919）结果：基线NT-proBNP > 400 pg/mL的患者的心血管事件发生率高于400 pg/mL的患者（39 vs 13起事件; p = 0.0002）。在NT-proBNP > 400 vs. 400 pg/mL的68 vs. 42例患者中开始透析（p = 0.0003）。在NT-proBNP > 400 pg/mL的患者中，治疗组之间的心血管事件风险（HR = 0.57; p = 0.08）或透析时间（HR = 0.65; p = 0.08）无显著差异。然而，该子研究的总体解释受限于其相对较小的样本量以及较低的临床事件发生率，导致某些分析缺乏统计功效，应视为本质上的假设生成。结论：在患有轻度至中度贫血的慢性肾病患者中，升高的基线血浆NT-proBNP水平与较高的心血管事件风险和向终末期肾病的加速进展相关。
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.