%0 Journal Article
%T The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost?
%A Shaffer R. S. Mok
%A Jose Avila
%A Barry Milcarek
%A Richard Kasama
%J Emergency Medicine International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/836497
%X Background. The NT-ProBNP/BNP test has been validated as a marker for determining the etiology of acute dyspnea. In the setting of end-stage renal disease on hemodialysis (ESRD on HD), the utility of the NT-ProBNP/BNP test has not been validated. This study examines the clinical utility of the NT-ProBNP test in the setting of ESRD on HD patients presenting with acute dyspnea. Methods. A retrospective case series of 250 subjects were admitted to Cooper University Hospital, 07/2010-03/2011, with ESRD and HD presenting with dyspnea. The incidences of echocardiography, cardiology consultation, and NT-ProBNP elevated and normal were examined. Correlation coefficients were calculated for NT-ProBNP with age (years), estimated dry weight (kg), amount of fluid removed (L), and ejection fraction (EF in %) among other echocardiography parameters. Results. Of the total sample 235 patients had NT-ProBNP levels performed. Cardiology consults were placed in 68.8% and 58% who underwent echocardiography. Of those for whom an echocardiography was performed estimated mean EFs of 54.6%, 50.8%, and 61.7% were observed among the NT-ProBNP elevated group, normal group, and no NT-ProBNP group, respectively. No differences were detected in all other echocardiography measurements. No correlation was observed between NT-ProBNP and age ( ), baseline EDW ( ), amount of fluid removed ( ), or EF ( ). Conclusion. In the setting of ESRD on HD, the NT-ProBNP test has no clinical utility in determining the etiology of acute dyspnea. This can be demonstrated through echocardiographic and therapeutic parameters measured in this study. 1. Introduction Both N-Terminus Pro Brain Natriuretic Peptide (NT-ProBNP) and Brain Natriuretic Peptide (BNP) hormones have been used in patients presenting with a chief complaint of dyspnea to predict whether Left Ventricular Systolic Dysfunction (LVSD) is causative for this symptom. The breathing not properly data and studies by Morrison, et al. demonstrated a high positive predictive value (PPV) for predicting congestive heart failure as the etiology of patients presenting with dyspnea to the emergency department [1¨C5]. The sensitivity and specificity of the BNP assay has been reported to be high, if serum concentrations are greater than 100 picograms per milliliter (pg/mL) for BNP and 500£¿pg/mL for NT-ProBNP for predicting LVSD as the etiology of dyspnea [6, 7]. Thus with a high pretest probability, members of the emergency department utilize the NT-ProBNP and BNP in the decision tree to treat patients presenting with dyspnea. The presence of chronic
%U http://www.hindawi.com/journals/emi/2013/836497/