title: Diagnostic value of B-type natriuretic peptide for estimating left atrial size and its usefulness for predicting all-cause mortality and cardiovascular events among chronic haemodialysis patients.
abstract: OBJECTIVE
  Estimating fluid balance in haemodialysis patients is essential when determining dry weight, but limited methods are currently available. B-type natriuretic peptide (BNP) is a useful surrogate marker in patients with congestive heart failure (CHF), but whether its validity could be generalized to haemodialysis patients has not been studied well.
  
  
  METHODS
  A total of 457 haemodialysis patients at a dialysis centre were analyzed. Determinants of BNP were assessed in connection with ultrasound cardiography (UCG) records, Kt/V, ultrafiltration rate (UFR), and demographic factors. All-cause death and cardiovascular (CV) events were recorded as the main outcome.
  
  
  RESULTS
  Among the UCG records, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), were determinants of log-transformed (ln) BNP; UFR, age and sex were also significant. There was a positive correlation between BNP and LAD (r = 0.285, P < 0.001). Receiver operating characteristic (ROC) analysis revealed that BNP had 90% and 80% sensitivity to predict the presence of LA enlargement of 77.9 pg/mL and 133.2 pg/mL, respectively. Higher BNP and lower LVEF were associated with higher risk for developing all-cause death and CVD. In the adjusted model, patients with BNP higher than 471 pg/mL had hazard ratio of 2.18 (95% confidence interval (CI) 1.20-3.96, P = 0.01), compared to those with BNP <109 pg/mL.
  
  
  CONCLUSIONS
  B-type natriuretic peptide was determined by LAD, LVEF, UFR, age and sex. BNP and LAD had positive correlation and BNP could become a useful tool for estimating the presence of LA enlargement. BNP and LVEF was a strong risk factor for predicting all-cause death and CV events among patients undergoing haemodialysis.
authors.affiliation: Department of Nephrology, Shuuwa General Hospital, Saitama, Japan; Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishigami
authors.forename: Soichiro
authors.initials: S
authors.lastname: Iimori
authors.forename: Michio
authors.initials: M
authors.lastname: Kuwahara
authors.forename: Sei
authors.initials: S
authors.lastname: Sasaki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsukamoto
mesh_terms: D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D006332:Cardiomegaly / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left; D014882:Water-Electrolyte Balance
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; cardiovascular disease; chronic kidney disease; haemodialysis; ultrasound cardiography