Predictive Value of Brain Natriuretic Peptides in Patients on Peritoneal Dialysis

Paniagua, Ramón; Amato, Dante; Mujais, Salim; Vonesh, Edward F.; Ramos, Adriana; Correa‐Rotter, Ricardo; Hörl, Walter H.

doi:10.2215/cjn.03820907

Cited by 70 publications

(52 citation statements)

References 61 publications

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“…Our data also corroborate earlier studies [38, 39] linking an elevated NT-proBNP to systemic inflammation in uremia. This association putatively reflects the close correlations between inflammation and CVD in uremia [13, 23], as well as the fact that myocardial ischemia in LVD is an important inducer of low-grade inflammation [19, 40] that also reflects the mortality risk in these patients regardless of the presence of renal dysfunction [41, 42].…”

Section: Discussionsupporting

confidence: 93%

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

Guo

Bárány²,

Qureshi³

et al. 2008

Am J Nephrol

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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.

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Section: Discussionsupporting

confidence: 93%

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

Guo

Bárány²,

Qureshi³

et al. 2008

Am J Nephrol

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“…Previous studies showed that serum TnT and NT-proBNP had predictive value for survival in CAPD patients and that measurement of those cardiac biomarkers may be of value in guiding risk stratification and, potentially, targeted therapeutic interventions (41,42). Our study failed to demonstrate differences between our groups of patients in serum levels of TnT and NT-proBNP.…”

Section: Discussioncontrasting

confidence: 67%

“…First, it is not feasible in dialysis studies to recruit a sample large enough to provide statistical power adequate to assess the individual endpoints of death, cause-specific death, hospitalization, and other events (20). Second, compared with other dialysis populations, our patients are healthier, with a higher protein catabolic rate, a lower incidence of diabetes, and fewer cardiovascular complications (42,43). Lastly, adjustments were not made in our study for other comorbid factors such as obesity, smoking, and exercise.…”

Section: Discussionmentioning

confidence: 99%

A Study of the Clinical and Biochemical Profile of Peritoneal Dialysis Fluid Low in Glucose Degradation Products

et al. 2012

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♦ Objective: Although peritoneal dialysis (PD) is a widely accepted form of renal replacement therapy, concerns remain regarding the bioincompatible nature of standard PD fluid (PDF). Short-term studies of new biocompatible PDFs low in glucose degradation products (GDPs) reveal divergent results with respect to peritoneal integrity. ♦ Methods: We studied 125 patients on maintenance PD who were assigned, by simple randomization, to receive either conventional or low-GDP PDF at PD initiation. Parameters of dialysis adequacy and peritoneal transport of small solutes were determined at initiation and after a period of maintenance PD at the time when serum and overnight effluent dialysate were simultaneously collected and assayed for various cytokines, chemokines, adipokines, and cardiac biomarkers. All patients were further followed prospectively for an average of 15 months from the day of serum and effluent collection to determine patient survival and cardiovascular events. ♦ Results: Patients treated with conventional or low-GDP PDF were matched for sex, age, duration of dialysis, dialysis adequacy, and incidence of cardiovascular disease or diabetes. After an average of 2.3 years of PD treatment, the weekly total and peritoneal creatinine clearance, and the total and peritoneal Kt/V were comparable in the groups. However, urine output was higher in patients using low-GDP PDF despite there having been no difference between the groups at PD initiation. Patients using low-GDP PDF also experienced a slower rate of decline of residual glomerular filtration and urine output than did patients on conventional PDF. Compared with serum concentrations, effluent concentrations of tumor necrosis factor α, hepatocyte growth factor, macrophage migration inhibitory factor, interleukins 8 and 6, C-reactive protein, and leptin were found to be higher in both groups of patients after long-term PD, suggesting that the peritoneal cavity was the major source of those mediators. Compared with patients on low-GDP PDF, patients on conventional fluid showed elevated leptin and reduced adiponectin levels in serum and effluent. The effluent concentration of interleukin 8 was significantly lower in patients using low-GDP PDF. The survival rate and incidence of cardiovascular complications did not differ between these groups after maintenance PD for an average of 3.6 years.

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“…Observational studies have found that low levels of salt and water removal, independent of residual renal function, are associated with worse survival (1,2). It is not clear, however, whether this association is causal, with excess tissue hydration or expanded plasma volume (PV) accelerating organ dysfunction, or simply evidence that there are difficulties in achieving euvolemia due to confounding factors such as cardiac dysfunction, inflammation, or poor dietary intake (3)(4)(5).…”

mentioning

confidence: 99%

Plasma Volume, Albumin, and Fluid Status in Peritoneal Dialysis Patients

John

Tan²,

Dainty³

et al. 2010

Clinical Journal of the American Society of Nephrology

112

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Predictive Value of Brain Natriuretic Peptides in Patients on Peritoneal Dialysis

Abstract: Conclusions. NT-proBNP have a significant predictive value for survival of CAPD patients and may be of value in guiding risk stratification and potentially targeted therapeutic interventions.

Cited by 70 publications

References 61 publications

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

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

A Study of the Clinical and Biochemical Profile of Peritoneal Dialysis Fluid Low in Glucose Degradation Products

Plasma Volume, Albumin, and Fluid Status in Peritoneal Dialysis Patients

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