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

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posted on 16.12.2020, 09:24 by Nete Tofte, Simone Theilade, Signe A Winther, Sørine Birkelund, Jens P Goetze, Tine W Hansen, Peter Rossing
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.

Funding

The present study was supported by the Novo Nordisk Foundation (grant number NNF14OC0013659 “PROTON Personalizing treatment of diabetic kidney disease” and internal funding from Steno Diabetes Center Copenhagen, Gentofte, Denmark.

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