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5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
Published on: July 3, 2013
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Changes in Natriuretic Peptide Levels and Subsequent Kidney Function Decline in SPRINT.
Simon B Ascher1, Jarett D Berry2, Ronit Katz3
1Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco; Division of Hospital Medicine, University of California, Davis, Sacramento.
Summary
Changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) during blood pressure treatment predict kidney function decline. Increases in NT-proBNP are linked to faster kidney function loss, especially in those with chronic kidney disease (CKD).
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Hypertension management requires better methods to predict kidney disease risk.
- The impact of intensive blood pressure lowering on kidney outcomes remains uncertain.
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) reflects cardiac stress and may indicate kidney risk.
Purpose of the Study:
- To investigate the association between longitudinal NT-proBNP changes and kidney function decline during hypertension treatment.
- To assess if NT-proBNP changes can serve as a dynamic marker for kidney disease risk.
Main Methods:
- Prospective observational study of 8,005 participants from the Systolic Blood Pressure Intervention Trial (SPRINT).
- Measurements included NT-proBNP at baseline and 1 year, with categorization of NT-proBNP change (decrease, increase, stable).
- Estimated glomerular filtration rate (eGFR) change was assessed using linear mixed-effect and logistic regression models, stratified by baseline chronic kidney disease (CKD) status.
Main Results:
- A ≥25% decrease in NT-proBNP was associated with slower eGFR decline in participants with and without CKD.
- A ≥25% increase in NT-proBNP was linked to faster eGFR decline and increased risk of a ≥30% eGFR decrease, particularly in participants with CKD.
- These associations were independent of baseline kidney function and blood pressure treatment intensity.
Conclusions:
- Changes in NT-proBNP during blood pressure treatment are independently associated with subsequent kidney function decline.
- NT-proBNP emerges as a potential dynamic tool for monitoring kidney risk, especially in patients with CKD.
- Further research should evaluate the utility of routine NT-proBNP measurements in managing hypertension-related kidney disease.
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