Comparison of Natriuretic Peptides as Risk Markers for All-Cause Mortality and Cardiovascular and Renal Complications in Individuals With Type 1 Diabetes

Objective

Few studies have compared Midregional Proatrial Natriuretic Peptide (MR-proANP) and N-terminal pro-brain natriuretic peptide (NT-proBNP). We compared their value as risk markers for all-cause mortality, cardiovascular (CV) and renal complications in persons with type 1 diabetes.

Research design and methods

MR-proANP and NT-proBNP were measured in 664 individuals. Hazard ratios (HR) were assessed per doubling of NT-proBNP or MR-proANP for risk of a composite of ischemic events, heart failure (HF), a combined renal endpoint of end-stage kidney disease (ESKD), decline in estimated glomerular filtration rate (eGFR) ≥30% and all-cause mortality or individual endpoints. Adjustments included CV risk factors and addition of MR-proANP or NT-proBNP.

Results

Median follow-up was 5.1-6.2 years. MR-proANP was associated with higher risk of all-cause mortality n=57; HR 1.7, 95% CI 1.1-2.7, combined CV endpoint (n=94; 1.6(1.1-2.2)), HF (n=27; 2.8(1.5-5.2)), combined renal endpoint (n=123; 1.6(1.2-2.1)) and ESKD (n=21; 3.1(1.2-7.8)) independent of CV risk factors (p≤0.02). After addition of NT-proBNP significance for all endpoints was lost. A doubling of NT-proBNP was associated with higher risk of all-cause mortality (1.5(1.2-1.8)), the combined CV endpoint (1.3(1.1-1.5)), HF (1.7(1.3-2.1)) and the combined renal endpoint (1.3(1.1-1.4)) independent of CV risk factors (model 2;p<0.001) and MR-proANP (model 3;p≤0.03). There was no association with decline in eGFR ≥30% (n=93).

Conclusions

Higher NT-proBNP was independently associated with all-cause mortality, CV disease, HF and the combined renal endpoint. MR-proANP was associated with all endpoints but decline in eGFR, although not independent of NT-proBNP. MR-proANP may contribute to the predictive value of NT-proBNP for risk-stratification in type 1 diabetes.