N-terminal pro brain natriuretic peptide predicts mortality in patients with end-stage renal disease in hemodialysis

Abstract

Concentrations of N-terminal pro brain natriuretic peptide (NT-proBNP) increase in patients with heart failure and other cardiovascular (CV) diseases and are strong prognostic markers. In patients with end-stage renal disease (ESRD) in hemodialysis (HD), levels of NT-proBNP are almost always raised. In ESRD patients undergoing HD, we aimed at (i) identifying the factors that affect levels of NT-proBNP, (ii) determining the effect of HD on NT-proBNP, and (iii) determining the prognostic impact of NT-proBNP. A total of 109 patients underwent physical examination, electrocardiogram, and echocardiography. Serum NT-proBNP was measured before and after HD (Elecsys 2010). NT-proBNP levels were markedly elevated (pre-HD 4079 pg/ml, post-HD 2759 pg/ml, P<0.001). There was a strong inverse correlation between NT-proBNP and left ventricular ejection fraction (LVEF) (P=0.043), 24-h urine production (P=0.006), and K(t)/V (efficacy of dialysis) (P=0.016) and a positive correlation with left ventricular hypertrophy (LVH) (P=0.014). Patients with higher concentrations, both pre- and post-HD had an increased mortality rate compared to those with lower concentrations (P=0.007, P=0.002). We found age (P=0.009) and NT-proBNP (pre-HD P=0.007, post-HD P=0.001) predictive of death. Our findings demonstrate that CV disease in terms of LVH and reduced LVEF in addition to 24-h urine production and K(t)/V determine NT-proBNP levels. Post-HD levels of NT-proBNP were lower than pre-HD levels; both predictive of mortality.

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

“…Thus, our study did not show any sustained association between log NT-proBNP and cardiac function as assessed by transthoracic echocardiogram or ATP myocardial perfusion scintography. Other studies have reported an association between BNP and markers of left ventricular hypertrophy rather than volume status (19,20); however, in one of these studies, BNP values were lower in those hemodialysis patients with greater residual renal function and thereby potentially less fluid-overloaded (20). In both of these studies, the median BNP values were substantially greater than those in our study (19,20), as were the levels of overhydration (20).…”

High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

“…Our results remained robust, even after adjustment for eGFR and proteinuria and in subgroups stratified by eGFR, proteinuria, and diabetic status. NT-proBNP regulates BP and body fluid volume by its natriuretic and diuretic actions, arterial dilation, and inhibition of the renin-aldosterone-angiotensin system, 24 and increased levels of this marker likely reflect myocardial stress induced by subclinical changes in volume or pressure, even in persons without clinical heart disease. Our findings are consistent with prior studies of the general population that have shown NT-proBNP to be strongly associated with HF.…”

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

“…Because B-type natriuretic peptide (BNP) is released by the left ventricle in response LV end-diastolic wall stress (2), this biomarker has been studied as a predictor of patient outcome. Our group and others have demonstrated that a single elevated BNP concentration strongly predicts cardiovascular and all-cause mortality in patients undergoing dialysis (3,4). Concentrations of BNP are frequently elevated in patients with CKD, particularly those receiving dialysis, and more so for the inactive N-terminal end NT-BNP-76 than the active 32-amino acid peptide BNP-32 (3).…”