title: Increasing B-type natriuretic peptide levels predict mortality in unselected haemodialysis patients.
abstract: OBJECTIVE
  Cardiac disease is the major cause of death in patients undergoing chronic haemodialysis. Recent studies have found that B-type natriuretic peptide (BNP) levels accurately reflect the cardiovascular burden of dialysis patients. However, the prognostic potential of BNP measurements in dialysis patients remains unknown.
  
  
  RESULTS
  The study included 113 chronic dialysis patients who were prospectively followed up. Levels of BNP were measured at baseline and every 6 months thereafter. The potential of baseline BNP and annual BNP changes to predict all-cause and cardiac mortality were assessed as endpoints. Median follow-up was 735 (354-1459) days; 35 (31%) patients died, 17 (15%) of them from cardiac causes. Baseline BNP levels were similar among survivors and non-survivors, and failed to predict all-cause and cardiac death. Cardiac death was preceded by a marked increase in BNP levels. In survivors BNP levels remained stable [median change: +175% (+20-+384%) vs. -14% (-35-+35%) over the 18 months preceding either death or the end of follow-up, P< 0.001]. Hence, annual BNP changes adequately predicted all-cause and cardiac death in the subsequent year {AUC(all-cause) = 0.70 [SD 0.05, 95% CI (0.60-0.81)]; AUC(cardiac) = 0.82 [SD 0.04, 95%CI (0.73-0.90)]}. A BNP increase of 40% provided the best cut-off level. Cox regression analysis confirmed that annual increases over 40% were associated with a seven-fold increased risk for all-cause and cardiac death.
  
  
  CONCLUSIONS
  Annual BNP increases above 40% predicted all-cause and cardiac death in the subsequent year. Hence, serially measuring BNP levels may present a novel tool for risk stratification and treatment guidance of end-stage renal disease patients on chronic dialysis.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland. breidthardtt@uhbs.ch
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Stefan
authors.initials: S
authors.lastname: Kalbermatter
authors.forename: Thenral
authors.initials: T
authors.lastname: Socrates
authors.forename: Markus
authors.initials: M
authors.lastname: Noveanu
authors.forename: Theresia
authors.initials: T
authors.lastname: Klima
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Denes
authors.initials: D
authors.lastname: Kiss
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain