Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study.
BACKGROUND
Inflammation, overhydration and elevated cardiac biomarkers are related to outcome in haemodialysis (HD) patients. Here, we explored the relationship between the body composition (BC), inflammation and cardiac biomarker concentrations in HD patients longitudinally.


METHODS
A total of 44 HD patients were followed for 6 months. BC was assessed by multifrequency bioimpedance (BIA). Serum concentrations of cardiac troponin T (cTnT), high-sensitive C-reactive protein (hsCRP), brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) were assessed at 2 monthly intervals. The longitudinal data analysis was conducted with a marginal model.


RESULTS
During the follow-up, the parameters describing the BC were highly predictive of both BNP and NT-proBNP and independent of gender, time, hsCRP and cTnT concentrations. The intracellular water (ICW)/body weight (BW) ratio (reflecting malnutrition) exerted a negative effect, whereas the extracellular water (ECW)/BW ratio (reflecting overhydration) had a positive effect on BNP and NT-proBNP concentrations. HsCRP and cTnT concentrations were significantly associated with each other. Furthermore, NT-proBNP concentrations were predictive of cTnT and hsCRP concentrations.


CONCLUSIONS
In the present study, we find a significant relation between BIA-derived BC parameters and natriuretic peptide concentrations. This relationship was independent of the cardiac history of the patient and suggests that the natriuretic peptide levels are to some degree modifiable by changing a patient's fluid distribution. Moreover, cTnT, BNP, NT-proBNP and hsCRP were significantly related, showing a complex relation between overhydration, malnutrition, inflammation and cardiac biomarkers in dialysis patients.
Jacobs
Leo H
LH
Department of Clinical Chemistry, University Hospital Maastricht, Maastricht, the Netherlands. leo.jacobs@mumc.nl
van de Kerkhof
Jos J
JJ
Mingels
Alma M
AM
Passos
Valéria Lima
VL
Kleijnen
Vincent W
VW
Mazairac
Albert H
AH
van der Sande
Frank M
FM
Wodzig
Will K
WK
Konings
Constantijn J
CJ
Leunissen
Karel M
KM
van Dieijen-Visser
Marja P
MP
Kooman
Jeroen P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001823:Body Composition / Q000502:physiology; D001826:Body Fluids / Q000502:physiology*; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000503:physiopathology; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D045265:Natriuretic Peptides / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D012044:Regression Analysis; D006435:Renal Dialysis; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D045265:Natriuretic Peptides; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein