N-terminal-pro-B-type-natriuretic peptide associated with 2-year mortality from both cardiovascular and non-cardiovascular origins in prevalent chronic hemodialysis patients

Abstract

N-terminal-pro-B-type-natriuretic peptide (NT-proBNP) was a predictive marker of cardiovascular disease (CVD)-related death in chronic dialysis patients. NT-proBNP was also correlated with markers of inflammation, malnutrition and protein-energy wasting. We hypothesized whether NT-proBNP was also associated with non-CVD death in chronic dialysis patients. A prospective observational study for incidence of death in chronic dialysis patients was conducted. Prevalent chronic dialysis patients (n = 1310) were enrolled and followed for 24 months. One hundred forty-four deaths were recorded. Area under the curve using ROC analysis for NT-proBNP showed: all causes of death (0.761), CVD-related (0.750), infection and malignancy-related (0.702) and others and unknown (0.745). After adjusting for age, sex, hemodialysis vintage, cardiothoracic ratio, mean pre-dialysis systolic blood pressure, dry weight and basal kidney disease, the hazard ratios (95% confidence intervals) per 1-log NT-proBNP calculated using multivariate Cox analysis were: all causes of death, 3.83 (2.51–5.85); CVD-related, 4.30 (2.12–8.75); infection and malignancy-related, 2.41 (1.17-4.93); and others and unknown origin, 5.63 (2.57–12.37). NT-proBNP was significantly associated not only with CVD-relate but also with non-CVD-related deaths in this population of prevalent chronic dialysis patients.

Renal Clearance of N-Terminal pro-Brain Natriuretic Peptide Is Markedly Decreased in Chronic Kidney Disease

“…These results are consistent with previous reports noting a very high NT-proBNP in end-stage CKD patients with or without CHF. 25,26 NT-proBNP is often O-glycosylated in cardiac myocytes, 27 which may result in underestimation of total NT-proBNP level, which includes both glycosylated and non-glycosylated NT-proBNP, by the NT-proBNP assay system used in the present study. 15 The NT-proBNPCS-AO/NT-proBNPAO ratio, however, may not be influenced by O-glycosylation.…”

“…Plasma NT-proBNP is a useful biomarker for mortality including cardiovascular death, not only in CHF patients but also in the general population. 1 , 6 , 14 , 18 Given that NT-proBNP ranges widely in patients with CKD, 14 , 19 , 20 the percentage of peripheral NT-proBNP of cardiac origin remains unknown in these patients. To address the problem, we measured the plasma NT-proBNP level in the AO and CS in 544 consecutive patients with left-sided heart disease and compared hemodynamic parameters in CKD patients.…”

N-terminal Pro-B-Type Natriuretic Peptide and Malnutrition in Patients on Hemodialysis

“…Uremic malnutrition, also called malnutrition inflammation complex syndrome or protein energy wasting, corresponding to a decrease in energy and body protein, is a common problem in patients with end-stage renal disease (ESRD) undergoing HD and has been consistently associated with mortality in different populations [1][2][3][4][5].…”

“…In HD patients, changes in NT-proBNP can be related to noncardiac problems such as fluid overload, inflammation, or malnutrition. In this line, NT-proBNP was recently associated with 2-year mortality from both cardiovascular and noncardiovascular origins in 1,310 prevalent chronic HD patients [3]. e current review aimed to summarize findings from studies on the association between NT-proBNP and malnutrition in HD patients.…”

Characterisation of N-terminal pro-brain natriuretic peptide in dialysis patients and its reduced prognostic significance in the elderly

“…NT-proBNP was reported to be associated with coronary artery disease 12 , left ventricular dysfunction 13 , and volume overload 14 as well as associated higher NT-proBNP with predicted worse prognosis, all-cause mortality, and cardiovascular mortality 14,15 . In non-CKD patients, the diagnostic power of NT-proBNP was quite different among elderly vs. non-elderly patients under acute dyspnoeic setting 16 .…”