Cardiovascular disease in patients with chronic renal impairment: role of natriuretic peptides.

Although there is overwhelming evidence that natriuretic peptides might be helpful in the diagnosis and management of congestive heart failure patients, the relationship among brain natriuretic peptides (BNP), renal function, and the severity of heart failure is less clear. It is obvious that the metabolism and elimination of BNP and N-terminal prohormone brain natriuretic peptide (NT-proBNP) are different with BNP clearance less dependent upon renal function. This paper reviews current data about the diagnostic and predictive role of natriuretic peptides to detect cardiac events in patients with chronic kidney disease. Although BNP and Nt-proBNP can be used to diagnose acute heart failure and may help predict risk and future cardiac events in patients with chronic kidney disease (CKD), a strategy that incorporates their use in daily clinical practice is still lacking.