title: The association of mid-regional pro-adrenomedullin and mid-regional pro-atrial natriuretic peptide with mortality in an incident dialysis cohort.
abstract: High levels of the plasma peptides mid-regional pro-adrenomedullin (MR-proADM) and mid-regional pro-atrial natriuretic peptide (MR-proANP) are associated with clinical outcomes in the general population. Data in patients with chronic kidney disease are sparse. We therefore investigated the association of MR-proANP and MR-proADM levels with all-cause and cardiovascular (CV) mortality, CV events and peripheral arterial disease in 201 incident dialysis patients of the INVOR-Study prospectively followed for a period of up to more than 7 years. The overall mortality rate was 43%, thereof 43% due to CV events. Both baseline MR-proANP and MR-proADM were associated with higher risk of all-cause (HR = 1.44, p = 0.001 and HR = 1.32, p = 0.002, respectively) and CV mortality (HR = 1.75, p<0.001 and HR = 1.41, p = 0.007, respectively) after adjustment for age, sex, previous CV events, diabetes mellitus and time-dependent type of renal replacement therapy. We then stratified patients in high risk (both peptides in the upper tertile), intermediate risk (only one of the two peptides in the upper tertile) and low risk (none in the upper tertile). Although demographic, clinical and laboratory variables were similar among the intermediate and high risk group, to be with both parameters in the upper tertile was associated with a 3-fold higher risk for all-cause (HR = 2.87, p<0.001) and CV mortality (HR = 3.58, p = 0.001). In summary, among incident dialysis patients MR-proANP and MR-proADM were shown to be associated with all-cause and CV mortality, with the highest risk when both parameters were in the upper tertiles.
authors.affiliation: Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria.
authors.forename: Ghazaleh
authors.initials: G
authors.lastname: Gouya
authors.forename: Gisela
authors.initials: G
authors.lastname: Sturm
authors.forename: Claudia
authors.initials: C
authors.lastname: Lamina
authors.forename: Emanuel
authors.initials: E
authors.lastname: Zitt
authors.forename: Otto
authors.initials: O
authors.lastname: Freistätter
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.forename: Michael
authors.initials: M
authors.lastname: Wolzt
authors.forename: Florian
authors.initials: F
authors.lastname: Knoll
authors.forename: Friederike
authors.initials: F
authors.lastname: Lins
authors.forename: Karl
authors.initials: K
authors.lastname: Lhotta
authors.forename: Ulrich
authors.initials: U
authors.lastname: Neyer
authors.forename: Florian
authors.initials: F
authors.lastname: Kronenberg
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: C552580:midregional pro-atrial natriuretic peptide, human; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor