NT-proBNP in assessment of kidney dysfunction development in patients with diffuse large B-cell lymphoma receiving immune polychemotherapy.
Authors: Nozdricheva Anastasia S. , Lysenko Irina B. , Guskova Nailya K. , Nikolaeva Nadezhda V. , Kapuza Elena A. , Tishina Anna V. , Pushkareva Tatiana F. , Abakumova Svetlana V. , Golomeeva Nadezhda V. , Selyutina Olesya N. , Samaneva Natalia Yu. , Kamaeva Inna A. , Lisunova Zinaida P. , Tselishcheva Irina V. , Belgova Svetlana V. , Zakharchenko Viktoria R. , Zekhtser Ineya I. , Vladimirova Liubov Yu , Shevchenko Aleksey N. , Dimitriadi Sergey N. 
Published: June 2022

e19554

Background: The purpose of this study was to assess NT-proBNP as a marker of renal dysfunction in patients with diffuse large B-cell lymphoma receiving immune polychemotherapy. Methods: The study involved 24 patients aged 23-69 years (median 57 years) with a primary diagnosis of diffuse large B-cell lymphoma (DLBCL). The renal status was assessed by the blood serum levels of creatinine, urea, NT-proBNP (Vitros 5600, USA), sodium (Cobas b221, Switzerland) with the calculation of the glomerular filtration rate (GFR) according to the CKD-EPI formula, as well as urine levels of albumin (Cobas Integra 400 plus, Switzerland). The tests were conducted before and 48 hours after induction immune polychemotherapy (R-CHOP). Statistical evaluation of results was made using the Statistica 13.0 program. Results: The patients were divided into 2 groups depending on the GFR levels before the start of therapy: group 1 (n = 16) - GFR 108.04±13.9 mL/min/1.73 m2 (normal levels); group 2 (n = 8) - GFR 59.57±12.04 mL/min/1.73m2 (reduced levels). The studied parameters in group 1 were within the reference values before treatment: NT-proBNP 109.38±13.6 pg/mL, creatinine 72.67±7.96 μmol/L, urea 5.39±0.99 mmol/L, albumin in urine 4.34±0.51 mg/L. After 48 hours, a moderate increase in NT-proBNP up to 207.5±48.2 pg/mL (p > 0.05) was observed, without significant changes in other parameters. In group 2, a pronounced increase in NT-proBNP was observed initially: 694±206.47 pg/mL, which was 5.6 times higher than the upper limit of the reference interval (p < 0.001) and 6.4 times higher than the levels in group 1 (p < 0.001), together with a significant increase in urine levels of albumin - 43.93±12.03 mg/L. Creatinine (80.67±4.35 μmol/L) and urea (6.4±1.41 mmol/L) remained within the reference range. After 48 hours, NT-proBNP increased by 3.8 times, reaching 2675±602.4 pg/mL (p < 0.001), which was accompanied by an increase in urine albumin - 57.8±8.86 mg/L and serum creatinine – 102.2±5.37 μmol/L in comparison with the initial levels. The levels of urea remained unchanged (6.6±0.43 mmol/L). The sodium levels did not differ significantly between the groups and was 141.65±2.24 mmol/L in group 1 and 140.85±3.4 mmol/L in group 2 and did not change over time. According to the results, patients with an initially decreased GFR demonstrated an increase in the levels of NT-proBNP and albumin in the urine even before the start of polychemotherapy. Conclusions: NT-proBNP can be considered an early marker of renal dysfunction in patients with diffuse large B-cell lymphoma.