N-Terminal Pro-Brain Natriuretic Peptide Independently Predicts Protein Energy Wasting and Is Associated with All-Cause Mortality in Prevalent HD Patients

Abstract

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) has been demonstrated to be associated with cardiovascular disease (CVD) and mortality in end-stage renal disease patients. We hypothesized that common confounders, such as protein-energy wasting (PEW) and inflammation could modulate this relationship. Methods: NT-proBNP was measured in 222 prevalent hemodialysis (HD) patients (55.4% male, mean age 66 years, range 51–74) using commercial ELISA. Levels were related to clinical characteristics, biochemical markers and survival. Results: NT-proBNP levels were positively associated with IL-6 (ρ = 0.37, p <0.001) and C-reactive protein (ρ = 0.25, p <0.001), but negatively associated with serum IGF-1 (ρ = –0.34, p < 0.001), handgrip strength (ρ = –0.30, p <0.001) and body weight (ρ = –0.20, p < 0.001). In multivariate analysis, an NT-proBNP level above the cutoff of the receiver-operating curve (9,761 pg/ml) was associated with PEW (odds ratio = 2.30, p = 0.008) even following adjustment for age, dialysis vintage, inflammation and the Davies score. As expected, NT-proBNP predicted clinical CVD (odds ratio = 1.90, p = 0.05) and all-cause mortality (Cox regression hazard ratio = 1.57, p = 0.03) also after adjustment for confounders. Patients with an NT-proBNP above the cutoff also exhibited a higher mortality (Kaplan-Meier χ² = 13.95, p < 0.001). Conclusion: We demonstrate a novel association between NT-proBNP and PEW, which may be part of the explanation for the strong links between NT-proBNP and mortality in HD patients.

Biomarkers in Chronic Kidney Disease - The Linkage Between Inflammation, Ventricular Dysfunction and Overhydration

“…But most importantly, a strong correlation between NT-proBNP and CRP levels is found (figure 1), suggesting an association between left-ventricular filling pressure and inflammation among patients with CKD. This association between left-ventricular filling pressure and inflammation among CKD patients has been confirmed in subsequent years (Guo et al, 2009;Jacobs et al, 2010;Paniagua et al, 2010). Otherwise, the same studies and other authors (Booth et al, 2010) observed a relationship between cardiac and inflammatory biomarkers and volume overload.…”

“…Probably, this pathophysiological mechanism partly explains the high levels of BNP detected among patients with CKD. In fact, several studies have observed an association between natriuretic peptide levels and echocardiographic data of left ventricular hypertrophy and dysfunction among patients with CKD (Guo et al, 2009;Paniagua et al, 2010;Zocali et al, 2001). Natriuretic peptide levels among patients with CKD predict death, as it occurs in patients with heart failure and normal renal function.…”

Clustering of Unconventional Cardiovascular Risk Factors among Taiwanese Hemodialysis Patients

“…Finally, the measurement of the ankle-brachial index, a well-known screening tool for PVD, had been demonstrated to have a prognostic significance of cardiovascular survival in chronic HD patients [37]. Moreover, both arterial stiffness and N-terminal pro-brain natriuretic peptide were found to be associated with CAVD and all-cause mortality in HD patients [38, 39]. The lack of those thorough examinations in our study indicates more comprehensive investigations should be expected.…”

Determinants of N-Terminal Pro-Brain Natriuretic Peptide Variation in Hemodialysis Patients and Prediction of Survival

“…The clinical use of NT-proBNP in optimizing the treatment of patients with chronic heart failure has been shown by Januzzi et al [5]. NT-proBNP levels are influenced by factors such as sex, age, fluid status, nutritional status, body mass index, thyroid status and renal function [6,7,8]. NT-proBNP increases with the worsening of renal function and is more strongly related to the glomerular filtration rate than BNP [9].…”

“…Previous studies have shown that a single measurement of NT-proBNP is a predictor of mortality in hemodialysis patients [10,11,14,15] and that NT-proBNP levels are higher in dialysis patients with protein energy wasting (PEW) and/or inflammation [8]. Furthermore, using longitudinal data we have previously reported a strong relationship between inflammation and comorbidity, in particular congestive heart failure, whereas variation of NT-proBNP is reported to be low in nonrenal patients with stable heart failure [16,17].…”