Predictive role of BNP and NT-proBNP in hemodialysis patients.
BACKGROUND
Cardiovascular events (CVE) are a major cause of morbidity and mortality in end-stage renal disease (ESRD) patients. These patients are often excluded from CV clinical trials, and the prognostic factors associated with CVE in patients with ESRD have not been fully explored. We investigated the role of BNP and NT-proBNP in predicting the outcome and prognostic value in hemodialysis with ESRD patients.


METHODS
Baseline NT-proBNP and BNP, indices of dialysis adequacy, and biochemical characteristics were assessed in 217 dialysis patients with ESRD who were followed prospectively for 2 years or until death. CVE included cardiovascular death, myocardial infarction, heart failure and stroke.


RESULTS
Using multivariable Cox regression analysis, BNP and NT-proBNP remained predictive of cardiovascular mortality (BNP: hazard ratio 1.22, 95% confidence interval (CI) 1.21-11.04, p < 0.05; NT-proBNP hazard ratio 1.86, 95% CI 1.14-9.36, p < 0.05), fatal/nonfatal CHF (BNP: 1.35, 1.33-11.78, p < 0.05; NT-proBNP: 2.25, 1.54-12.68, p < 0.001) and fatal/nonfatal MI (BNP: 0.61, 2.38-19.53, p = 0.42; NT-proBNP: 1.90, 3.28-20.17, p < 0.001). NT-proBNP had better predictive value than BNP for mortality (area under the ROC curve (AUC) 0.83 vs. 0.61; p < 0.05).


CONCLUSIONS
These data showed that BNP and NT-proBNP are very sensitive and specific predictors of CVE in dialysis patients.
Sun
Linlin
L
Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China. pierre_delanaye@yahoo.fr
Sun
Yan
Y
Zhao
Xuezhi
X
Xu
Chenggang
C
Chen
Dongping
D
Li
Lin
L
Ma
Yiyi
Y
Rong
Shu
S
Mei
Changlin
C
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D051437:Renal Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain