title: 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.
authors.affiliation: Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Copenhagen, Denmark. lhm@dadlnet.dk
authors.forename: L H
authors.initials: LH
authors.lastname: Madsen
authors.forename: S
authors.initials: S
authors.lastname: Ladefoged
authors.forename: P
authors.initials: P
authors.lastname: Corell
authors.forename: M
authors.initials: M
authors.lastname: Schou
authors.forename: P R
authors.initials: PR
authors.lastname: Hildebrandt
authors.forename: D
authors.initials: D
authors.lastname: Atar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000502:physiology; D010446:Peptide Fragments / Q000097:blood* / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis / Q000209:etiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain