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Best use of cardiac biomarkers in patients with AL amyloidosis and renal failure
Author(s) -
Palladini Giovanni,
Foli Andrea,
Milani Paolo,
Russo Paola,
Albertini Riccardo,
Lavatelli Francesca,
Obici Laura,
Perlini Stefano,
Moratti Remigio,
Merlini Giampaolo
Publication year - 2012
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23141
Subject(s) - medicine , renal function , heart failure , natriuretic peptide , al amyloidosis , cardiology , amyloidosis , brain natriuretic peptide , urology , antibody , immunology , immunoglobulin light chain
In AL amyloidosis prognosis depends on the severity of heart dysfunction which is best assessed by natriuretic peptides (BNP and NT‐proBNP). However, their clearance relies on glomerular filtration rate (GFR) and their concentration increases with renal failure. We evaluated the diagnostic and prognostic performance of NT‐proBNP and BNP in 248 patients with AL amyloidosis with different degrees of renal failure. Patients were grouped according to GFR. Group 1 comprised 109 patients with GFR ≥60 mL/min/1.73 m 2 , Group 2, 77 subjects with GFR <60 and ≥15 mL/min/1.73 m 2 , and Group 3, 62 patients with GFR <15 mL/min/1.73 m 2 . The ability of natriuretic peptides to detect heart involvement and to predict survival in the three groups was assessed. Decreasing eGFR required higher cutoffs of both NT‐proBNP and BNP for detecting heart involvement and predicting survival. Both natriuretic peptides were independent prognostic markers in Groups 1 and 2, whereas in Group 3 only BNP independently predicted survival. Natriuretic peptides are powerful and useful markers of cardiac dysfunction and prognosis, provided that eGFR is considered in interpreting their clinical meaning. BNP should be preferred in patients with end‐stage renal failure. Am. J. Hematol. 87:465–471, 2012. © 2012 Wiley Periodicals, Inc.