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N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts the cardio-renal response to aliskiren in patients with type 2 diabetes at high renal and cardiovascular risk
Idzerda, Nienke M. A. Persson, Frederik Pena, Michelle J. Brenner, Barry M. Brunel, Patrick Chaturvedi, Nish McMurray, John Parving, Hans-Henrik de Zeeuw, D. Heerspink, Hiddo J. L.
Idzerda, Nienke M. A.
Persson, Frederik
Pena, Michelle J.
Brenner, Barry M.
Brunel, Patrick
Chaturvedi, Nish
McMurray, John
Parving, Hans-Henrik
de Zeeuw, D.
Heerspink, Hiddo J. L.
Abstract
Sodium retention and volume overload are the main determinants of poor response to reninangiotensin- aldosterone system (RAAS) inhibition in patients with diabetes. As volume excess can exist without symptoms, biomarkers are needed to identify a priori which patients are volume overloaded and may experience less benefit from RAAS inhibition. N-terminal pro-brain natriuretic peptide (NT-proBNP) is released in the setting of increased cardiac wall stress and volume overload. We conducted a post hoc analysis among 5081 patients with type 2 diabetes mellitus participating in the ALTITUDE trial to investigate whether NTproBNP can predict the effects of additional therapy with aliskiren on cardio-renal endpoints. Aliskiren compared to placebo reduced the risk of the primary cardio-renal endpoint events by 20% (95% confidence interval [CI] 16 to 61) and 2% (95% CI –42 to 30) in the two lowest NT-proBNP tertiles, and it increased the risk by 25% (95% CI –4 to 96) in the highest NT-proBNP tertile (P value for trend = 0.009). Similar trends were observed for the cardiovascular and end-stage renal disease endpoints. Effects of aliskiren compared to placebo on safety outcomes (hyperkalaemia and hospitalization for acute kidney injury) were independent of NT-proBNP. In conclusion, baseline NT-proBNP may be used as a marker to predict the response to aliskiren with regard to cardiorenal outcomes when added to standard therapy with RAAS inhibition.
Keywords
cardiovascular disease, clinical trial, diabetes complications, type 2 diabetes
Date
2018
Type
Journal article
Journal
Diabetes, Obesity and Metabolism
Book
Volume
20
Issue
12
Page Range
2899-2904
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled