Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study

Jacobs, Leo H J; Kerkhof, Jos J. van de; Mingels, Alma M.A.; Passos, Valéria Lima; Kleijnen, Vincent W.V.C.; Mazairac, Albert H.A.; Sande, Frank M. van der; Wodzig, Will K. W. H.; Konings, Constantijn; Leunissen, Karel M.L.; Dieijen-Visser, Marja P. van; Kooman, Jeroen P.

doi:10.1093/ndt/gfp417

Cited by 103 publications

(111 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An increase in BNP concentration over time in dialysis patients has been previously demonstrated for both NT-BNP-76 (7,14,15) and BNP-32 (16), although two other studies demonstrated no significant change in these markers (17,18). The concurrent measurement of both forms of BNP in three groups of patients allowed us to directly compare patients with CKD 3-4 and KTRs to dialysis patients.…”

Section: Discussionmentioning

confidence: 91%

Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant

Roberts

Hare

Sikaris³

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives B-type natriuretic peptide (BNP) concentration predicts outcome in patients undergoing dialysis. Because survival and cardiovascular risk change across the CKD continuum, serial changes in BNP were compared in patients at different CKD stages and after kidney transplantation.Design, setting, participants, & measurements Patients with CKD stages 3 and 4 (CKD 3-4), dialysis patients, and kidney transplant recipients (KTRs) from one center had two measurements of BNP taken a median of 161 days apart in 2003-2004 and were followed until July 2012. Both BNP-32 (Triage BNP; Biosite Diagnostics) and NT-BNP-76 (proBNP; Roche Diagnostics) were assayed. The interaction between change in log-transformed BNP concentration over time and patient group was tested by fitting regression models on panel data with random effects. Survival after the second measurement was compared by tertile of change in BNP.Results Patients with CKD 3-4 (n=48), dialysis patients (n=102), and KTRs (n=73) were followed for a median of 5.7, 4.8, and 5.9 years, respectively. The interaction between patient group and BNP measurements over time was significant for NT-BNP-76 (P,0.001) and BNP-32 (P,0.01). Median NT-BNP-76 increased in dialysis patients and those with CKD 3-4 from 3850 pg/ml (interquartile range [IQR], 1776-12,323 pg/ml) to 18,830 pg/ml (IQR, 6114-61,009 pg/ml; P,0.001) and from 698 pg/ml (IQR, 283-2922 pg/ml) to 2529 pg/ml (IQR, 347-9277 pg/ml; P=0.002), respectively. Change was not significant for KTRs or comparisons made with BNP-32. Survival rate was significantly lower for patients with the highest tertile of change in NT-BNP-76 among patients with CKD 3-4 (P=0.02), but not in the dialysis or KTR groups. In 11 patients who received a kidney transplant during the study, median NT-BNP-76 decreased from 9607 pg/ml (IQR, 2292-31,282 pg/ml) to 457 pg/ml (IQR, 203-863 pg/ml) after transplant (P,0.01).Conclusions The temporal trajectory of BNP differs between dialysis patients and those with CKD 3-4 and KTRs. This has important implications for the development of BNP-guided management strategies in CKD.

show abstract

Section: Discussionmentioning

confidence: 91%

Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant

Roberts

Hare

Sikaris³

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…contemporaneous volume assessment with pre-and postdialysis multifrequency bioimpedance. As with other reports, we found that NT-proBNP values were not normally distributed (2-7); therefore, we logarithmically transformed data to allow standard statistical analysis (12).…”

Section: Discussionmentioning

confidence: 94%

“…However, there has been debate as to whether NT-proBNP is a marker of volume overload (7,12) or a marker of left ventricular dysfunction (2,13), and also studies that have reported no association with changes in left ventricular mass index or volume status (14). We therefore audited NT-proBNP in a cohort of stable adult hemodialysis outpatients who had MAP, mean arterial blood pressure; CTR, cardiothoracic ratio on chest x-ray; LV, left ventricular; ECW/TBW, extracellular water to total body water ratio; ⌬ECF BSA , change in extracellular fluid volume corrected for body surface area; Pre, prehemodialysis; Post, posthemodialysis.…”

Section: Discussionmentioning

confidence: 99%

N-terminal proBNP—Marker of Cardiac Dysfunction, Fluid Overload, or Malnutrition in Hemodialysis Patients?

Booth

Pinney

Davenport

2010

Clinical Journal of the American Society of Nephrology

165

132

View full text Add to dashboard Cite

Background and objectives: N-terminal probrain type natriuretic peptide (NTproBNP) has been proven to be a valuable biomarker for predicting cardiac events and mortality in the hemodialysis population. However recent reports have suggested that NTproBNP is a marker of volume overload rather than one of cardiac dysfunction. Therefore this study investigated the effect of fluid volume status on NTproBNP.Design, setting, participants, & measurements: Volume status was determined pre-and postdialysis in 72 stable hemodialysis outpatients by multifrequency bioimpedance, and the relationship to NTproBNP values was examined.Results: The mean and median NTproBNP values were 931.9 ؎ 230 and 242 (90 to 688) pmol/L, respectively. On simple correlation, NTproBNP was associated with markers of volume overload and cardiac dysfunction. However, on logistical regression analysis, the strongest association was with the predialysis ratio of extracellular water/total body water (␤ 26.6, F29.6, P ‫؍‬ 0.000), followed by postdialysis mean arterial blood pressure (␤ 0.14, F17.1, P ‫؍‬ 0.000), dialysate calcium concentration (␤ ؊1.19, F14.1, P ‫؍‬ 0.002), and change in extracellular fluid volume with dialysis (␤ 0.27, F7.4, P ‫؍‬ 0.009) Conclusions: In this study, NTproBNP was not associated with cardiac dysfunction as assessed by transthoracic echo or nuclear medicine scintigraphy but was dependent on factors associated with volume overload. However, because bioimpedance results can also be affected by malnutrition with loss of cell mass, NTproBNP may be elevated not only in patients with volume overload, but also those with malnutrition.

show abstract

“…Figure 1 clearly indicates a BCM (and not FFM) depletion and a higher ratio of ECW to ICW in the DG, considering that 1) a high R is correlated to small amounts of FFM; 2) for the same body mass, a low Xc indicates a decrease in the amount of BCM; and 3) a decrease in PA may be due both to a worsening in the hydration of the FFM and a decrease in the amount of the BCM relative to the amount of the FFM. An increase in the ratio of ECW to ICW is expected as a result of the decrease in BCM, which, in turn, may be attributed to protein-energy malnutrition [41], fast weight loss [42], or catabolic stress [43], as well as to elevated adiposity levels [44][45][46]. It has been suggested that under these circumstances the assessment of BCM is especially important, because its depletion (as well as that of the SMM) may be masked by normal values of FFM [47], as was observed in our sample comparing DG with CG.…”

Section: Discussionmentioning

confidence: 99%

Bioimpedance vector analysis and conventional bioimpedance to assess body composition in older adults with dementia

et al. 2015

View full text Add to dashboard Cite

a b s t r a c tObjective: Although dementia and nutritional status have been shown to be strongly associated, differences in body composition (BC) among older people with dementia have not yet been firmly established. The aim of this study was to assess BC through conventional and vector bioimpedance analysis (BIA and BIVA, respectively) in a sample of institutionalized older men with and without dementia, in order to detect dementia-related BC changes. Methods: Forty-one institutionalized men ages 65 y (23 without dementia [CG] and 18 with dementia [DG]) were measured with BIA and interpreted with BIVA and predictive equations. Results: Age (74.4 and 75.7 y) and body mass index (22.5 and 23.6 kg/m 2 ) were similar for DG and CG, respectively. Resistance and ratio of resistance to height did not differ significantly between the two groups. Reactance and ratio of reactance to height were 21.2% and 20.4% lower in DG than in CG. Phase angle was significantly lower in DG (mean ¼ 4.0; 95% confidence interval [CI], 3.6 -4.3 ) than in CG (mean ¼ 4.7; 95% CI, 4.3 -5.1 ). Mean fat mass index (6 and 7 kg/m 2 ), and mean fat-free mass index (16.4 and 16.6 kg/m 2 ) were similar in both groups. BIVA showed a significant downward migration of the ellipse in DG with respect to CG (T 2 ¼ 15.1; P < 0.01). Conclusion: Conventional BIA showed no significant differences in BC between DG and CG, although reactance and ratio of reactance to height were about 21% lower in DG. Nevertheless, a body cell mass depletion and an increase in the ratio of extracellular to intracellular water were identified in DG using BIVA. BIVA reflects dementia-related changes in BC better than BIA.

show abstract

Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study

Cited by 103 publications

References 38 publications

Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant

Temporal Trajectory of B-Type Natriuretic Peptide in Patients with CKD Stages 3 and 4, Dialysis, and Kidney Transplant

N-terminal proBNP—Marker of Cardiac Dysfunction, Fluid Overload, or Malnutrition in Hemodialysis Patients?

Bioimpedance vector analysis and conventional bioimpedance to assess body composition in older adults with dementia

Contact Info

Product

Resources

About