B-type natriuretic peptide and interdialytic fluid retention are independent and incremental predictors of mortality in hemodialysis patients

Westenbrink, B. Daan; Hovinga, Tkk; Kloppenburg, Wybe; Veeger, Nic J. G. M.; Janssen, Wmt

doi:10.5414/cn106858

Cited by 12 publications

(14 citation statements)

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“…congestive heart failure, contribute in these patients. NT-proBNP has been described to be of significant value as a marker both of fluid overload [11] as well as of left ventricular dysfunction [4]; both factors seem to show a significant overlap in this special population [44]. …”

Section: Discussionmentioning

confidence: 99%

“…To date, only serum N-terminal brain natriuretic peptide (BNP) levels are known to be strongly associated with fluid overload [3,9,10] and have recently even been suggested as a guide for fluid management in hemodialysis patients [11]. Troponin T (TnT) and D-Dimer have been shown to be elevated in the dialysis population in general [12-14], but a direct association with fluid overload has not been demonstrated for TnT [3], or has not yet been studied, as in the case of D-dimer.…”

Section: Introductionmentioning

confidence: 99%

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Fluid overload in hemodialysis patients: a cross-sectional study to determine its association with cardiac biomarkers and nutritional status

et al. 2013

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BackgroundChronic fluid overload is associated with higher mortality in dialysis patients; however, the link with cardiovascular morbidity has not formally been established and may be influenced by subclinical inflammation. We hypothesized that a relationship exists between fluid overload and [i] cardiovascular laboratory parameter as well as between fluid overload and [ii] inflammatory laboratory parameters. In addition, we aimed to confirm whether volume status correlates with nutritional status.MethodsWe recorded baseline characteristics of 244 hemodialysis patients at three hemodialysis facilities in Vienna (Austria) and determined associations with volume measurements using the body composition monitor (Fresenius/Germany). In one facility comprising 126 patients, we further analyzed cardiovascular, inflammatory and nutritional parameters.ResultsWe detected predialysis fluid overload (FO) in 39% of all patients (n = 95) with FO defined as ≥15% of extracellular water (ECW). In this subgroup, the absolute FO was 4.4 +/-1.5 L or 22.9 ± 4.8% of ECW. A sub-analysis of patients from one center showed that FO was negatively associated with body mass index (r = -0.371; p = <0.001), while serum albumin was significantly lower in fluid overloaded patients (p = 0.001). FO was positively associated with D-Dimer (r = 0.316; p = 0.001), troponin T (r = 0.325; p < 0.001), and N-terminal pro-B-type natriuretic peptide (r = 0.436; p < 0.001), but not with investigated inflammatory parameters.ConclusionsFluid overload in HD patients was found to be lower in patients with high body mass index, indicating that dry weight was inadequately prescribed and/or difficult to achieve in overweight patients. The association with parameters of cardiovascular compromise and/or damage suggests that fluid overload is a biomarker for cardiovascular risk. Future studies should determine if this applies to patients prior to end-stage renal disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fluid overload in hemodialysis patients: a cross-sectional study to determine its association with cardiac biomarkers and nutritional status

et al. 2013

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“…BNP is a valuable predictive marker of mortality in congestive heart failure [12], acute coronary syndrome [13,14], cardiomyopathy [15], dialysis-dependent chronic renal failure [16] and even in a community-based population [17]. Therefore, admission BNP levels of patients with ICH would provide prognostic information for clinicians and help guide patient management.…”

Section: Discussionmentioning

confidence: 99%

“…It is primarily released from the ventricular myocardium and is a biomarker of congestive heart failure. BNP is also a predictive marker of mortality in various disorders [12,13,14,15,16] and in a general community-based population [17]. …”

Section: Introductionmentioning

confidence: 99%

Brain Natriuretic Peptide upon Admission as a Biological Marker of Short-Term Mortality after Intracerebral Hemorrhage

et al. 2014

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Background and Purpose: The purpose of the present study was to test the hypothesis that plasma brain natriuretic peptide (BNP) is associated with short-term mortality after intracerebral hemorrhage (ICH). Methods: We prospectively enrolled 271 patients (median age 72 years; 109 females) who were admitted within 24 h of ICH onset between April 2007 and July 2011 and in whom plasma BNP levels were measured upon admission. The patients were assigned to two groups according to survival within 1 month of ICH. Factors associated with mortality were determined by multivariate logistic regression analysis. Results: Within 1 month of ICH, 48 (17.7%) of the 271 enrolled patients died. The median (interquartile range) level of plasma BNP was significantly higher in the group of non-survivors than in the group of survivors [102.5 (48.7-205.0) vs. 32.4 (17.3-85.0) pg/ml; p < 0.001]. A cutoff BNP level of 60.0 pg/ml could predict death within 1 month of ICH. Multivariate logistic regression analysis showed that a plasma BNP of >60.0 pg/ml (OR 4.7; 95% CI 1.43-15.63; p = 0.011) was independently associated with mortality within 1 month after ICH. Conclusions: A high BNP level upon admission is associated with mortality within 1 month after ICH.

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“…Notable is that TnT has molecular size of 37 kDa but also exists as fragments ranging in size from 8 kDa to 30 kDa (26,27), and troponin I has size between 21 kDa to 24 kDa (28). The cardiac markers are all predictors of increased risk of mortality (13,17,18,21,24,(29)(30)(31)(32).…”

Section: Introductionmentioning

confidence: 99%

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

et al. 2015

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Background Brain natriuretic peptide (BNP), N-terminal-proBNP (NT-proBNP), and high sensitive cardiac troponin T (TnT) are markers that are elevated in chronic kidney disease and correlate with increased risk of mortality. Data are conflicting on the effect of biomarker levels by hemodialysis (HD). Our aim was to clarify to what extent HD with low-flux (LF) versus high-flux (HF) membranes affects the plasma levels of BNP, NT-proBNP, and TnT. Methods and Materials 31 HD patients were included in a crossover design, randomized to start dialysis with a LF-HD or HF-HD dialyzer. Each patient was his/her own control. The dialyses included in the study were the first treatments of two consecutive weeks with each mode of dialysis. Patients normally on hemodiafiltration (HDF) also performed a HDF the third week. Values after HD were corrected for extent of ultrafiltration. Results During LF-HD the biomarkers NT-proBNP and TnT increased (15 versus 6%, P≤.001) while there was a slight decrease in BNP (P<.05). During HF-HD the NT-proBNP, BNP and TnT levels decreased (P≤.01 for all). During HDF all three markers decreased (P<.01 for all). The rise in TnT during LF-HD correlated with dialysis vintage (months on HD, r = .407, P = .026), Kt/V-urea (r = .383, P = .037), HD time in hours/treatment (r = .447, P = .013) and inversely with residual urinary output (r = -.495, P = .005). The baseline levels of BNP and NT-proBNP correlated with blood pressure. Conclusions Cardiac biomarkers increase slightly during LF-HD. A HF-HD eliminates the biomarkers and can mask increases caused by, e.g., myocardial infarction.

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B-type natriuretic peptide and interdialytic fluid retention are independent and incremental predictors of mortality in hemodialysis patients

Cited by 12 publications

References 0 publications

Fluid overload in hemodialysis patients: a cross-sectional study to determine its association with cardiac biomarkers and nutritional status

Fluid overload in hemodialysis patients: a cross-sectional study to determine its association with cardiac biomarkers and nutritional status

Brain Natriuretic Peptide upon Admission as a Biological Marker of Short-Term Mortality after Intracerebral Hemorrhage

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

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