title: NT-proBNP, fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients.
abstract: BACKGROUND
  N-terminal fragment of B-type natriuretic peptide (NT-proBNP) is a marker of both fluid volume overload and myocardial damage, and it has been useful as a predictor of mortality in patients with end-stage renal disease (ESRD). It has been suggested that continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and haemodialysis (HD) may have different effects on fluid volume and blood pressure control; however, whether the independent predictive value of NT-proBNP for mortality is preserved when analysed in conjunction with fluid overload and dialysis modality is not clear.
  
  
  METHODS
  A prospective multicentre cohort of 753 prevalent adult patients on CAPD, APD and HD was followed up for 16 months. Plasmatic levels of NT-proBNP, extracellular fluid volume/total body water ratio (ECFv/TBW) and traditional clinical and biochemical markers for cardiovascular damage risk were measured, and their role as predictors of all-cause and cardiovascular mortality was analysed.
  
  
  RESULTS
  NT-proBNP level, ECFv/TBW and other cardiovascular damage risk factors were not evenly distributed among the different dialysis modalities. NT-proBNP levels and ECFv/TBW were correlated with several inflammation, malnutrition and myocardial damage markers. Multivariate analysis showed that NT-proBNP levels and ECFv/TBW were predictors of both all-cause and cardiovascular mortality, independently of dialysis modality and the presence of other known clinical and biochemical risk factors.
  
  
  CONCLUSIONS
  NT-proBNP is a reliable predictor of death risk independently of the effect of dialysis modality on fluid volume control, and the presence of other clinical and biochemical markers recognized as risk factors for all-cause and cardiovascular mortality. NT-pro-BNP is a good predictor of mortality independently of fluid volume overload and dialysis modality.
authors.affiliation: Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, Mexico City. jpaniaguas@cis.gob.mx
authors.forename: Ramón
authors.initials: R
authors.lastname: Paniagua
authors.forename: María-de-Jesús
authors.initials: MD
authors.lastname: Ventura
authors.forename: Marcela
authors.initials: M
authors.lastname: Avila-Díaz
authors.forename: Héctor
authors.initials: H
authors.lastname: Hinojosa-Heredia
authors.forename: Antonio
authors.initials: A
authors.lastname: Méndez-Durán
authors.forename: Alfonso
authors.initials: A
authors.lastname: Cueto-Manzano
authors.forename: Alejandra
authors.initials: A
authors.lastname: Cisneros
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ramos
authors.forename: Clara
authors.initials: C
authors.lastname: Madonia-Juseino
authors.forename: Francisco
authors.initials: F
authors.lastname: Belio-Caro
authors.forename: Fernando
authors.initials: F
authors.lastname: García-Contreras
authors.forename: Pedro
authors.initials: P
authors.lastname: Trinidad-Ramos
authors.forename: Rosario
authors.initials: R
authors.lastname: Vázquez
authors.forename: Begoña
authors.initials: B
authors.lastname: Ilabaca
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Alcántara
authors.forename: Dante
authors.initials: D
authors.lastname: Amato
mesh_terms: D000328:Adult; D045604:Extracellular Fluid; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain