19969
document
B-type natriuretic peptide for acute dyspnea in patients with kidney disease : insights from a randomized comparison . BACKGROUND B-type natriuretic peptide ( BNP ) levels are reliably elevated in patients with congestive heart failure ( CHF ) and therefore helpful in its diagnosis . However , kidney disease results in elevated BNP levels independently of CHF . Accordingly , the impact of kidney disease on the benefit of BNP testing needs to be scrutinized . METHODS This study evaluated patients with and without kidney disease [ glomerular filtration rate ( GFR ) less than 60 mL/min/1.73 m ( 2 ) ) presenting with acute dyspnea . A total of 452 consecutive patients ( 240 with kidney disease and 212 without kidney disease ) were randomly assigned to a diagnostic strategy with ( BNP group ) or without ( control group ) the use of BNP levels provided by a rapid bedside assay . RESULTS Patients with kidney disease were older , more often had CHF as the cause of acute dyspnea , and more often died in-hospital or within 30 days as compared to patients without kidney disease . In patients without kidney disease , BNP testing significantly reduced median time to discharge ( from 9.5 days to 2.5 days ) ( P= 0.003 ) and total cost of treatment ( from 7184 dollars to 4151 dollars ) ( P= 0.004 ) . In contrast , in patients with kidney disease , time to discharge and total cost of treatment were similar in both groups . CONCLUSION When applying BNP cut-off values without adjustment for the presence of kidney disease , the use of BNP levels does significantly improve the management of patients without kidney disease , but not of those with kidney disease .
19970
Intervention_Pharmacological
B-type natriuretic peptide
19971
Intervention_Pharmacological
B-type natriuretic peptide ( BNP ) levels
19972
Intervention_Pharmacological
BNP
19973
Intervention_Physical
BNP testing
19974
Intervention_Pharmacological
BNP
19975
Intervention_Pharmacological
BNP levels
19976
Outcome_Physical
B-type natriuretic peptide ( BNP ) levels
19977
Outcome_Physical
CHF as the cause of acute dyspnea
19978
Outcome_Physical
median time to discharge
19979
Outcome_Other
total cost of treatment
19980
Outcome_Physical
BNP levels
19981
Participant_Condition
patients with kidney disease :
19982
Participant_Condition
patients with congestive heart failure ( CHF )
19983
Participant_Condition
patients with and without kidney disease [ glomerular filtration rate ( GFR ) less than 60 mL/min/1.73 m ( 2 ) ) presenting with acute dyspnea .
19984
Participant_Sample-size
452 consecutive patients
19985
Participant_Sample-size
240 with kidney disease
19986
Participant_Sample-size
212 without kidney disease
19987
Participant_Condition
Patients with kidney disease were older , more often had CHF as the cause of acute dyspnea , and more often died in-hospital or within 30 days as compared to patients without kidney disease