N-terminal pro-B-type natriuretic peptide and mortality in renal transplant recipients versus the general population.
BACKGROUND
Mortality rates are higher in renal transplant recipients (RTR) than in the general population (GP). It is unknown what risk factors account for this difference.


METHODS
We prospectively followed a cohort of 606 RTR for 3026 person-years, during which 95 died. A GP cohort of 3234 subjects was followed for 24,940 person-years, during which 130 died.


RESULTS
All investigated risk factors, except ethnicity, body mass index, and total cholesterol, differed significantly between cohorts, with an adverse risk profile in the RTR. The age-adjusted and gender-adjusted hazard ratio for mortality in RTR was 6.2 (95% confidence interval [CI] 4.6-8.3) compared with GP, which was reduced to 2.4 (95% CI 1.6-3.6), 4.3 (95% CI 3.0-6.1), and 5.0 (95% CI 3.5-7.3) after additional adjustment for differences in N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatinine clearance, and need for antihypertensive medication, respectively (all P<0.001), whereas adjustment for variables more related to atherosclerosis, including history of cardiovascular disease, diabetes, and high-density lipoprotein cholesterol, did not affect the difference in mortality between RTR and GP. Associations of NT-proBNP, creatinine clearance, and the use of antihypertensive medication with mortality were significantly steeper in RTR than in GP. Risk for mortality was similar for RTR and GP with low NT-proBNP (<100 pg/mL).


CONCLUSIONS
Elevated NT-proBNP, low creatinine clearance, and need for antihypertensive medication are stronger risk factors for mortality in RTR than in GP. The increased mortality seen in the RTR population may well be related to cardiac failure rather than "accelerated atherosclerosis."
Oterdoom
Leendert H
LH
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. oterdoom@gmail.com
de Vries
Aiko P J
AP
van Ree
Rutger M
RM
Gansevoort
Ron T
RT
van Son
Willem J
WJ
van der Heide
Jaap J Homan
JJ
Navis
Gerjan
G
de Jong
Paul E
PE
Gans
Reinold O B
RO
Bakker
Stephan J L
SJ
D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D002102:Cadaver; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality* / Q000502:physiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000633:toxicity*; D010446:Peptide Fragments / Q000633:toxicity*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D014019:Tissue Donors
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain