1
|
Kawagoe C, Sato Y, Toida T, Nakagawa H, Yamashita Y, Fukuda A, Iwatsubo S, Fujimoto S. N-terminal-pro-B-type-natriuretic peptide associated with 2-year mortality from both cardiovascular and non-cardiovascular origins in prevalent chronic hemodialysis patients. Ren Fail 2018; 40:127-134. [PMID: 29457529 PMCID: PMC6014467 DOI: 10.1080/0886022x.2018.1437047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
N-terminal-pro-B-type-natriuretic peptide (NT-proBNP) was a predictive marker of cardiovascular disease (CVD)-related death in chronic dialysis patients. NT-proBNP was also correlated with markers of inflammation, malnutrition and protein-energy wasting. We hypothesized whether NT-proBNP was also associated with non-CVD death in chronic dialysis patients. A prospective observational study for incidence of death in chronic dialysis patients was conducted. Prevalent chronic dialysis patients (n = 1310) were enrolled and followed for 24 months. One hundred forty-four deaths were recorded. Area under the curve using ROC analysis for NT-proBNP showed: all causes of death (0.761), CVD-related (0.750), infection and malignancy-related (0.702) and others and unknown (0.745). After adjusting for age, sex, hemodialysis vintage, cardiothoracic ratio, mean pre-dialysis systolic blood pressure, dry weight and basal kidney disease, the hazard ratios (95% confidence intervals) per 1-log NT-proBNP calculated using multivariate Cox analysis were: all causes of death, 3.83 (2.51–5.85); CVD-related, 4.30 (2.12–8.75); infection and malignancy-related, 2.41 (1.17-4.93); and others and unknown origin, 5.63 (2.57–12.37). NT-proBNP was significantly associated not only with CVD-relate but also with non-CVD-related deaths in this population of prevalent chronic dialysis patients.
Collapse
Affiliation(s)
- Chihiro Kawagoe
- a Dialysis Division , University of Miyazaki Hospital , Miyazaki , Japan
| | - Yuji Sato
- a Dialysis Division , University of Miyazaki Hospital , Miyazaki , Japan
| | - Tatsunori Toida
- b Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine , University of Miyazaki , Miyazaki , Japan
| | - Hideto Nakagawa
- a Dialysis Division , University of Miyazaki Hospital , Miyazaki , Japan
| | - Yasuhiro Yamashita
- c Department of Internal Medicine, Division of Circulatory and Body Fluid Regulation, Faculty of Medicine , University of Miyazaki , Miyazaki , Japan
| | - Akihiro Fukuda
- a Dialysis Division , University of Miyazaki Hospital , Miyazaki , Japan
| | - Shuji Iwatsubo
- c Department of Internal Medicine, Division of Circulatory and Body Fluid Regulation, Faculty of Medicine , University of Miyazaki , Miyazaki , Japan
| | - Shouichi Fujimoto
- b Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine , University of Miyazaki , Miyazaki , Japan
| |
Collapse
|
2
|
Kubo S, Iwasaki M, Horie M, Matsukane A, Hayashi T, Tanaka Y, Hase H, Joki N. Biological variation of procalcitonin levels in hemodialysis patients. Clin Exp Nephrol 2018; 23:402-408. [PMID: 30196520 DOI: 10.1007/s10157-018-1639-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/21/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is no obvious evidence regarding biological variation of procalcitonin (PCT) levels in hemodialysis (HD) patients without infections. The aim of this study was to determine the within- and between-person biological variation of PCT levels in HD patients without infections. METHODS A multicenter, prospective, cohort study enrolled 123 HD patients without any signs of infectious disease. Baseline PCT levels were determined pre- and post-HD, and then repeated pre-HD PCT measurements were performed at 2, 4, 8, 12, 16, 20, and 24 weeks after baseline blood-sampling, regardless of the presence or absence of infectious disease. Analytical variation (CVa), the within-person biological variation (CVi), between-person biological variation (CVb), individual index (II), and the reference change value (RCV) were calculated. RESULTS The mean age was 62.4 years, 76.4% were male, and 32.5% had diabetes. The mean duration of HD was 87 months. The median value for baseline pre-HD PCT was 0.23 ng/mL, which is much higher than the reference level for healthy individuals. PCT levels decreased of 46.6% after a single HD session. CVi was 24.9%, CVb was 54.2%, II was 0.46, and RCV was calculated as 96.4% with 99% probability. CONCLUSIONS The PCT level was significantly higher in stable HD patients without manifest bacterial infection. CVb was more variable than CVi in HD patients, which indicates that relative change is more important than absolute PCT levels for diagnosing bacterial infection, and doubling or more of the baseline PCT level may imply the presence of a bacterial infection in HD patients.
Collapse
Affiliation(s)
- Shun Kubo
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Masaki Iwasaki
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Mari Horie
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Ai Matsukane
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Toshihide Hayashi
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Hiroki Hase
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
| |
Collapse
|
3
|
Wyskida K, Ficek J, Ficek R, Adamska D, Jędrzejowska P, Wajda J, Klein D, Witkowicz J, Rotkegel S, Spiechowicz-Zatoń U, Kocemba-Dyczek J, Ciepał J, Więcek A, Olszanecka-Glinianowicz M, Chudek J. N-Terminal Prohormone of Brain Natriuretic Peptide but not C-Terminal Pre-Pro Vasopressin (Copeptin) Level is Associated with the Response to Antihypertensive Therapy in Haemodialysis Patients. Kidney Blood Press Res 2017; 42:1013-1022. [PMID: 29190613 DOI: 10.1159/000485433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Volume overload, frequently clinically asymptomatic is considered as a causative factor limiting the effectiveness of antihypertensive therapy in haemodialysis (HD) patients. Therefore, the aim of this study was to assess plasma levels of N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) and a C-terminal portion of the precursor of vasopressin (CT-proAVP, copeptin), surrogate markers of volume overload in HD patients in relation to the number of antihypertensive drugs used in the hypertension treatment. METHODS One hundred and fifty adult HD patients (92 males) were enrolled into this study. Clinical data concerning blood pressure (BP) measurements prior haemodialysis session and pharmacotherapy were collected from all patients. In addition to routine laboratory parameters, plasma levels of NT-proBNP and CT-proAVP were measured, and daily sodium and water consumption were estimated with a portion-size food frequency questionnaire. RESULTS Among 145 (96.7%) hypertensive HD patients, 131 were receiving antihypertensive medication. Despite antihypertensive therapy, 31.0% had inadequate BP control. Plasma concentration of NT-proBNP was associated with systolic (R=0.19; p=0.02) but not diastolic BP values and with the number of received antihypertensive drugs (R=0.21; p=0.01). The highest NT-proBNP values were observed in patients receiving 3 or more antihypertensive drugs. In contrast, no significant correlation was found between plasma CT-proAVP concentrations and BP values as well as and the number of antihypertensive drugs. Receiver operator curve analysis showed that NT-proBNP values over 13,184 pg/mL predicted the use of at least 3 antihypertensive drugs in maximal doses in the therapy of hypertension, similar analyses performed for CT-proAVP showed much less specificity. CONCLUSIONS 1. Increased levels of NT-proBNP seems to be a better biomarker of multidrug antihypertensive therapy requirement than CT-proAVP. 2. Whether estimation of NT-proBNP in these patients will be also better biomarker than copeptin in the prediction of cardiovascular complications related to hypertension needs further investigations.
Collapse
Affiliation(s)
- Katarzyna Wyskida
- Health Promotion and Obesity Management Unit, Department of Pathophysiology Medical University of Silesia, Katowice, Poland
| | - Joanna Ficek
- Pathophysiology Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Rafał Ficek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Dagmara Adamska
- Health Promotion and Obesity Management Unit, Department of Pathophysiology Medical University of Silesia, Katowice, Poland
| | - Patrycja Jędrzejowska
- Health Promotion and Obesity Management Unit, Department of Pathophysiology Medical University of Silesia, Katowice, Poland
| | - Jarosław Wajda
- Dialysis Center in Rybnik, Regional Specialist Hospital No. 3 in Rybnik, Rybnik, Poland
| | - Dariusz Klein
- Dialysis Center in Tychy, Centrum Dializa Sosnowiec, Sosnowiec, Poland.,Dialysis Center in Pszczyna, Centrum Dializa Sosnowiec, Sosnowiec, Poland
| | | | - Sylwia Rotkegel
- Dialysis Center in Katowice, Centrum Dializa Sosnowiec, Sosnowiec, Poland
| | | | - Joanna Kocemba-Dyczek
- Dialysis Center in Żory, Centrum Dializa Sosnowiec, Sosnowiec, Poland.,Dialysis Center in Wodzisław Śląski, Centrum Dializa Sosnowiec, Sosnowiec, Poland
| | - Jarosław Ciepał
- Dialysis Center in Sosnowiec, Centrum Dializa Sosnowiec, Sosnowiec, Poland
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | | | - Jerzy Chudek
- Pathophysiology Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Poland.,Dialysis Center in Katowice, Centrum Dializa Sosnowiec, Sosnowiec, Poland
| |
Collapse
|
4
|
Xiang F, Chen R, Cao X, Shen B, Liu Z, Tan X, Ding X, Zou J. Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study. Hemodial Int 2017; 22:82-92. [PMID: 28403540 DOI: 10.1111/hdi.12549] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Patients with chronic kidney disease, especially those with end-stage renal disease, have an increased risk of death. Previous studies have suggested neutrophil/lymphocyte ratio (NLR) was related to worse outcome in patients undergoing hemodialysis (HD). However, monocyte/lymphocyte ratio (MLR) has not been evaluated in HD patients. In this study, we prospectively studied the predictive value of MLR for all-cause and cardiovascular mortality in HD patients and compared it with NLR. METHODS Patients who had been on a HD treatment for at least 6 months were enrolled. MLR was calculated by dividing the monocyte count by the lymphocyte count. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic impact of MLR and other clinical factors on all-cause and cardiovascular mortality. RESULTS Mortality rates for the lowest, middle, and highest MLR tertile group were 3.65, 7.02, and 11.15, respectively per 100 patient-years. The Kaplan-Meier analysis revealed that survival rates were significantly different among three MLR groups (P < 0.001). In multivariate Cox regression analyses, MLR was independently associated with all-cause mortality (HR 4.842; 95% CI, 2.091-11.214; P < 0.001) and cardiovascular mortality (HR 6.985, 95% CI 1.943-25.115, P = 0.003) as continuous variables. NLR was not an independent predictor of all-cause nor cardiovascular mortality after adjusted with MLR. CONCLUSIONS The main finding of the study suggest that higher MLR was a strong and independent predictor of all-cause and cardiovascular mortality and overwhelmed NLR among HD patients.
Collapse
Affiliation(s)
- Fangfang Xiang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China
| | - Rongyi Chen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Lab of Kidney and Blood Purification, Shanghai, China
| | - Xuesen Cao
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhonghua Liu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao Tan
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China
| | - Jianzhou Zou
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Lab of Kidney and Blood Purification, Shanghai, China
| |
Collapse
|
5
|
Okute Y, Shoji T, Hayashi T, Kuwamura Y, Sonoda M, Mori K, Shioi A, Tsujimoto Y, Tabata T, Emoto M, Inaba M. Cardiothoracic Ratio as a Predictor of Cardiovascular Events in a Cohort of Hemodialysis Patients. J Atheroscler Thromb 2016; 24:412-421. [PMID: 27629255 PMCID: PMC5392479 DOI: 10.5551/jat.36426] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The cardiothoracic ratio (CTR) on a chest X-ray is an indicator of cardiac enlargement, although its predictive power for cardiovascular disease (CVD) events in chronic kidney disease is unknown. We examined it in a cohort of hemodialysis patients, as compared with an N-terminal fragment of probrain natriuretic peptide (NT-proBNP). METHOD This was an observational study with cross-sectional and longitudinal analyses including 517 maintenance hemodialysis patients and 122 healthy control subjects. The main predictors were CTR and serum NT-proBNP, and the main outcome was CVD events in 5 years. RESULTS At baseline, the hemodialysis patients had higher median (interquartile range) levels of CTR [0.487 (0.457-0.520)] than the control group [0.458 (0.432-0.497)]. In the hemodialysis group, CTR was positively correlated with NT-proBNP (Spearman's r=0.44, P<0.001). During follow-up, 190 CVD events occurred. CTR was significantly associated with the risk of CVD [HR 2.12 (95% CI, 1.38-3.25) for the fourth quartile as compared with the second quartile of CTR] in a multivariate Cox model. In the same model, NT-proBNP (fourth versus first quartile) showed a HR of 3.27 (2.02-5.31). When CTR and NT-proBNP were simultaneously included as predictors, only NT-proBNP remained a significant predictor of CVD events, all-cause mortality and composite of CVD plus all-cause mortality. CONCLUSIONS We showed that CTR was a significant and independent predictor of CVD in hemodialysis patients. CTR can be used for CVD risk stratification in hemodialysis patients when NT-proBNP is not available.
Collapse
Affiliation(s)
- Yujiro Okute
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|