Aminoterminal B-type natriuretic peptide (NT-proBNP) in end-stage renal failure patients on regular hemodialysis: does it have diagnostic and prognostic implications?
BACKGROUND
Amino-terminal B-type natriuretic peptide (NT-proBNP) quantification is a useful cardiovascular diagnostic and prognostic test. In renal failure its use may have constraints, as it depends on renal clearance. We aimed to evaluate the clinical usefulness of NT-proBNP in hemodialysis (HD) patients.


METHODS
We measured NT-proBNP levels in 44 patients before and after a regular high-flux HD. Cardiac parameters were evaluated by echocardiography. Patients were followed up for 656.5 +/- 476.4 days for the occurrence of hospital admission or death.


RESULTS
NT-proBNP levels decreased after HD (p < 0.0001) without correlation with ultrafiltration volume, Kt/V index, weight decrease or pulse pressure decrease. Pre- and post-HD NT-proBNP were similar in patients with and without left ventricular hypertrophy. Pre-HD levels were not significantly associated with prognosis, probably due to a type 2 error; post-HD NT- proBNP and NT-proBNP reduction ratio (RR) were predictive of the outcome by Kaplan-Meier analysis, but only RR remained associated with prognosis on multivariate regression analysis (hazard ratio 0.96; 95% confidence interval 0.93-0.99).


CONCLUSIONS
Our results do not support the use of NT-proBNP in the diagnosis of left ventricular hypertrophy or volume status in HD patients, but suggest its utility in prognostic stratification. HD-related variation in NT-proBNP was associated with prognosis.
Pimenta
Joana
J
Internal Medicine Department, Hospital S. João, Porto, Portugal. joanapimenta@clix.pt
Sampaio
Francisco
F
Martins
Patrícia
P
Carvalho
Berta
B
Rocha-Gonçalves
Francisco
F
Ferreira
António
A
Bettencourt
Paulo
P
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000150:complications / Q000175:diagnosis; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D006435:Renal Dialysis
D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain