Predictive value of brain natriuretic peptides in patients on peritoneal dialysis: results from the ADEMEX trial.
OBJECTIVE
Natriuretic peptides have been suggested to be of value in risk stratification in dialysis patients. Data in patients on peritoneal dialysis remain limited.


METHODS
Patients of the ADEMEX trial (ADEquacy of peritoneal dialysis in MEXico) were randomized to a control group [standard 4 x 2L continuous ambulatory peritoneal dialysis (CAPD); n = 484] and an intervention group (CAPD with a target creatinine clearance > or =60 L/wk/1.73 m(2); n = 481). Natriuretic peptides were measured at baseline and correlated with other parameters as well as evaluated for effects on patient outcomes.


RESULTS
Control group and intervention group were comparable at baseline with respect to all measured parameters. Baseline values of natriuretic peptides were elevated and correlated significantly with levels of residual renal function but not with body size or diabetes. Baseline values of N-terminal fragment of B-type natriuretic peptide (NT-proBNP) but not proANP(1-30), proANP(31-67), or proANP(1-98) were independently highly predictive of overall survival and cardiovascular mortality. Volume removal was also significantly correlated with patient survival.


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.
Paniagua
Ramon
R
Mexican Nephrology Collaborative Study Group, Unidad de Investigacioñ Médica en Enfermedades Nefrolìicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Amato
Dante
D
Mujais
Salim
S
Vonesh
Edward
E
Ramos
Alfonso
A
Correa-Rotter
Ricardo
R
Horl
Walter H
WH
D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate
D020097:Natriuretic Peptide, Brain