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Diabetes Care 28:752, 2005
© 2005 by the American Diabetes Association, Inc.

Letters: Observations

B-Type Natriuretic Peptide in Type 2 Diabetes

The influence of chronic renal failure and food

Liu Chung, MD1, Agnès Georges, PHARMD2, Jean Benoit Corcuff, MD, PHD2, Laurence Bordenave, MD, PHD2, Henri Gin, MD, PHD1 and Vincent Rigalleau, MD, PHD1

1 Nutrition-Diabétologie, Hopital Haut-Lévêque and Université Victor Segalen-Bordeaux 2, Pessac, France
2 Médecine Nucléaire, Hopital Haut-Lévêque and Université Victor Segalen-Bordeaux 2, Pessac, France

Address correspondence to Vincent Rigalleau, Nutrition-Diabétologie, Hopital Haut-Lévêque, Avenue de Magellan, 33600 Pessac, France. E-mail: vincent.rigalleau{at}wanadoo.fr

Cardiac ventricles release B-type natriuretic peptide (BNP) in response to volume expansion and pressure overload; therefore, BNP concentration may be used as a biochemical marker of cardiac failure (1). BNP levels are high in diabetic subjects with left ventricular dysfunction (2). Because the diagnosis of cardiac failure may be an emergency (3), it is important to know whether the timing of BNP measurement (before or after a meal) affects the result. The effect of renal failure is also an important practical issue, since 25–40% of diabetic subjects have diabetic nephropathy. This study was designed to describe the changes elicited by chronic renal failure (CRF) and meal consumption on BNP levels in diabetic patients.

Thirty diabetic patients were divided into two groups: 15 patients without CRF (group 1: glomerular filtration rate [GFR]) by Cockcroft’s formula >60 ml/min) and 15 patients with CRF (group 2: GFR <60 ml/min). No patient presented significant cardiac history based on clinical examination, electrocardiograph recording, and chest radiography. Four blood samples were collected before and 1, 2, and 3 h (T0 to T3) after a standardized meal (72 g carbohydrates, 21 g lipids, and 32 g proteins) to measure plasma BNP concentrations (IRMA Shionoria-BNP, Schering Cis Bio). Mean BNP levels (±SD) for the two groups were compared using the Mann-Whitney U test. Values for repeated data before and after lunch were compared by ANOVA.

Sex, age, BMI, type of diabetes, HbA1c, and blood pressure were similar in the two groups. GFR was lower in group 2 (group 1: 92 ± 20, group 2: 36 ± 15 ml/min; P < 0.001). No significant difference was found between BNP concentrations before and after lunch in both groups (group 1: T = 12.3 ± 23.1, T1 = 11.7 ± 21.9, T2 = 12.3 ± 21.9, T3 = 12.5 ± 23.2 pg/ml; group 2: T = 34.9 ± 37.9, T1 = 34.7 ± 38.9, T2 = 35.9 ± 36.7, T3 = 35.7 ± 39.4 pg/ml). The BNP concentrations were higher in group 2 (P < 0.05 for each time). When the two groups were analyzed together, BNP concentrations were negatively correlated with GFR (r = –0.56, P < 0.005).

Natriuretic peptides play many physiological roles; therefore, determining whether feeding affects BNP concentrations is a practical problem. Plasma {alpha}-atrial natriuretic peptide concentrations are increased by feeding in nondiabetic subjects (4). We show here that feeding does not affect plasma BNP levels in diabetic patients; blood samples can be drawn at any time for BNP measurement.

In nondiabetic patients, BNP distinguishes patients with a left ventricular hypertrophy and CRF (5). In our study, plasma BNP concentrations were higher in diabetic patients with CRF before and after feeding. Plasma BNP may therefore be used to monitor the cardiac function in diabetic subjects with CRF, but its reduced clearance participating in its increased concentrations needs to be taken into account.

References

  1. Cardarelli R, Lumicao TG: B-type natriuretic peptide : a review of its diagnostic, prognostic, and therapeutic monitoring value in heart failure for primary care physicians. Clin Rev 16:327–333, 2003
  2. Epshteyn V, Morrison K, Kishnaswamy P, Kazanegra R, Clopton P, Mudaliar S, Edelman S, Henry R, Maisel A: Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes. Diabetes Care 26:2081–2087, 2003[Abstract/Free Full Text]
  3. Wu AH, Omland T, Duc P, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Wold Knudsen C, Storrow AB, Abraham WT, Perez A, Kamin R, Clopton P, Maisel AS, McCullough PA: The effect of diabetes on B-type natriuretic peptide concentrations in patients with acute dyspnea: an analysis from the Breathing Not Properly Multinational Study. Diabetes Care 27:2398–404, 2004[Abstract/Free Full Text]
  4. Chattington PD, Anderson JV, Rees LH, Leese GP, Peters JR, Vora JP: Atrial natriuretic peptide in type 2 diabetes mellitus: response to a physiological mixed meal and relationship to renal function. Diabet Med 15:375–379, 1998[Medline]
  5. Peter A, Joseph K, Vandana S: Diagnostic and therapeutic utility of B-type natriuretic peptide in patients with renal insufficiency and decompensated heart failure. Rev Cardiovasc Med 4:S3–S12, 2003

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This Article
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