N-terminal pro-brain natriuretic peptide independently predicts protein energy wasting and is associated with all-cause mortality in prevalent HD patients.
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 (rho = 0.37, p <0.001) and C-reactive protein (rho = 0.25, p <0.001), but negatively associated with serum IGF-1 (rho = -0.34, p < 0.001), handgrip strength (rho = -0.30, p <0.001) and body weight (rho = -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 chi(2) = 13.95, p < 0.001).


CONCLUSIONS
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.
Guo
Qunying
Q
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Bárány
Peter
P
Qureshi
Abdul Rashid
AR
Snaedal
Sunna
S
Heimburger
Olof
O
Stenvinkel
Peter
P
Lindholm
Bengt
B
Axelsson
Jonas
J
D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D016016:Proportional Hazards Models; D011502:Protein-Energy Malnutrition / Q000097:blood* / Q000150:complications; D012372:ROC Curve; D013548:Sweden / Q000453:epidemiology
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain