Elevated brain natriuretic peptide is associated with abnormal heart geometry in children with chronic kidney disease.

AIM: It was to establish whether brain natriuretic peptide (BNP) might predict cardiac dysfunction in children with chronic kidney disease (CKD). METHODS: The relation between BNP, echocardiography and risk factors (hypertension, anemia, lipids, CRP, hyperparathyroidism) was investigated in 46 children (10 pre-dialysis patients, 14 on dialysis, 11 children with kidney transplants, and 11 healthy controls). Data on BNP were transformed into common logarithms (log(10) BNP, log BNP). RESULTS: log BNP was significantly higher in dialysis patients when compared to controls (2.09 +/- 0.78 vs. 1.43 +/- 0.34 pg/ml, p = 0.012) and patients in the pre-dialysis stage (2.09 +/- 0.78 vs. 1.52 +/- 0.42 pg/ml, p = 0.039). log BNP in transplanted children was not significantly different from healthy children (2.09 +/- 0.78 vs. 1.71 +/- 0.46 pg/ml, p = 0.19). Abnormal heart geometry (concentric and eccentric hypertrophy, concentric remodeling) was found in 19 patients (54.28%). A significant correlation was observed between log BNP and ventricular hypertrophy (r = 0.515, p = 0.001). Compared to controls higher log BNP was seen in children with eccentric hypertrophy than in children with concentric hypertrophy (2.178 +/- 0.956 vs. 1.496 +/- 0.395 pg/ml, p = 0.05, or 1.982 +/- 0.618 vs. 1.496 +/- 0.395, p = 0.04). CONCLUSIONS: BNP might predict an abnormal geometry in children with CKD.

[Brain natriuretic peptide might predict the abnormal geometry of heart in children with chronic kidney disease]. / Mozgový natriuretický peptid môze predikovat' zmenu geometrie srdca u detí s chronickou oblickovou chorobou.

BACKGROUND: Cardiovascular diseases are the leading course of morbidity/mortality in children with chronic kidney disease. Recently it has been shown that a brain natriuretic peptide is a sensitive cardiac marker for classification of the cardiovascular risk in adults. Whether it has the same diagnostic value in children with chronic kidney diseases has to be established. The purpose of the study was to evaluate whether the brain natriuretic peptide can predict cardiac dysfunction in children with chronic kidney disease. METHODS AND RESULTS: Relation between serum level of the brain natriuretic peptide, echocardiography and cardiovascular risk factors (hypertension, anaemia, lipids, C-reactive protein, secondary hyperparathyreoidism) has been studied in 46 children (10 patients at predialysis, 14 patients on dialysis, 11 children with kidney transplant and 11 healthy controls). Brain natriuretic peptide was significantly higher in dialysed patients (2.09 +/- 0.78) in comparison with healthy children (1.43 +/- 0.34, p = 0.012) and with both groups of patients at pre-dialysis stage (1.52 +/- 0.42, p = 0.039) and after kidney transplant (1.71 +/- 0.46, p = 0.19). Abnormal heart geometry was found in 19 patients (54.28%). Compared to controls, brain natriuretic peptide was higher in children with eccentric but not in those with concentric hypertrophy (2.178 +/- 0.956 vs. 1.496 +/- 0.395, p = 0.05, resp. 1.982 +/- 0.618 vs. 1.496 +/- 0.395, p = 0.04). Significant correlation was found between levels of brain natriuretic peptide and ventricular hypertrophy (p = 0.001), with the level of parathyroid hormone (p = 0.03) and with the degree of anaemia (p = 0.027). CONCLUSIONS: Brain natriuretic protein can predict an abnormal geometry of heart in children with chronic kidney disease. Our preliminary results suggest that it is a suitable marker of cardiovascular classification in paediatrics.