Superior predictive value for NTproBNP compared with high sensitivity cTnT in dialysis patients: a pilot prospective observational study

High sensitivity cardiac troponin, a cardiac marker predicting death in patients with kidney disease: a dose-response Meta-analysis of cohort studies

BACKGROUND

Patients with kidney disease are at increased risk of adverse mortality events. Numerous studies have demonstrated the positive association of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) with all-cause and cardiovascular (CV) mortality in patients with kidney disease; however, the dose-response meta-analysis have not been reported. We therefore performed this study to evaluate the dose-response associations of hs-cTn with risk of all-cause and CV mortality to improve risk stratification.

METHODS

We searched three databases (PubMed, Embase, and Web of Science) to identify relevant prospective cohort studies published up to January 12, 2021. Random-effects models were used to summarize relative risks (RRs) and 95% confidence intervals (CIs) of all-cause and CV mortality. Restricted cubic splines were used to fit the dose-response associations.

RESULTS

For each 10 ng/L increase in hs-cTnT and hs-cTnI, the risk increased by 14% (RR = 1.14, 95% CI, 1.10-1.18) and 19% (RR = 1.19, 95% CI, 1.09-1.31) for all-cause mortality, 25% (RR = 1.25, 95% CI, 1.13-1.38) and 19% (RR = 1.19, 95% CI, 1.10-1.29) for CV mortality. A linear trend was found between hs-cTnT and all-cause mortality, whereas a non-linear trend was found in hs-cTnI. Additionally, both hs-cTnT and hs-cTnI were shown to have linear trends with CV mortality.

CONCLUSION

Our meta-analysis suggests that hs-cTn had high sensitivity in predicting mortality events. All dose-response trends were rising rather than falling, conferring that any increase in the levels of hs-cTn may possibly predict a death prognosis among CKD patients.

Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis

OBJECTIVE

To evaluate the role of bioimpedance-defined overhydration (BI-OH) parameters in predicting the risk of mortality and cardiovascular (CV) events in patients undergoing dialysis.

METHODS

We searched multiple electronic databases for studies investigating BI-OH indicators in the prediction of mortality and CV events through 23 May 2020. We assessed the effect of BI-OH indexes using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was used for each outcome.

RESULTS

We included 55 studies with 104,758 patients in the meta-analysis. Extracellular water/total body water (ECW/TBW) >0.4 (HR 5.912, 95% CI: 2.016-17.342), ECW/intracellular water (ICW) for every 0.01 increase (HR 1.041, 95% CI: 1.031-1.051), and OH/ECW >15% (HR 2.722, 95% CI: 2.005-3.439) increased the risk of mortality in patients receiving dialysis. ECW/TBW >0.4 (HR 2.679, 95% CI: 1.345-5.339) and ECW/ICW per increment of 10% (HR 1.032, 95% CI: 1.017-1.047) were associated with an increased risk of CV events in patients undergoing dialysis. A 1-degree increase in phase angle was a protective factor for both mortality (HR 0.676, 95% CI: 0.474-0.879) and CV events (HR 0.736, 95% CI: 0.589-0.920).

CONCLUSIONS

BI-OH parameters might be independent predictors for mortality and CV events in patients undergoing dialysis.

Assessment and Management of Volume Overload Among Patients on Chronic Dialysis

Volume overload is the most common complication in end-stage renal disease (ESRD) patients, being directly related to numerous complications including resistant hypertension, cardiac hypertrophy, congestive heart failure or arterial stiffness, among others. Therefore, volume overload is now considered an important risk factor for hard outcomes, like all-cause or cardiovascular mortality. Relying solely on clinical examination for assessing volume overload in ESRD patients lacks sensitivity and specificity. Numerous efforts have been made to identify new methods that could objectively assess volume status; however, each of them has important limitations. This review aims to discuss the most frequently used methods (biomarkers, inferior vena cava assessment, lung ultrasonography, bioimpedance analysis and blood volume monitoring) and to compare the advantage of each method vs. the overall/ clinical strategy.

Pathophysiology and significance of natriuretic peptides in patients with end-stage kidney disease

Natriuretic peptides (NP), especially B type (BNP) and its N-terminal pro-B type natriuretic peptide (NT-proBNP), have long been regarded as biomarkers of volume overload and tools to exclude heart failure in the general population. However, their role in end-stage kidney disease (ESKD) is less certain given that BNP and NT-proBNP are excreted by the kidney and so serum concentrations of NPs are nearly universally elevated compared to controls. Nevertheless, the accumulated evidence suggests thatserum concentrations of NPs in patients with ESKD show moderate or strong positive relationships with underlying heart disease, abnormal cardiac structure or function and mortality. Limited evidence also supports the role of BNP including NT-proBNP, ANP in some studies, rather than CNP or DNP in risk stratification among ESKD patients as well as the utility of BNP samplings pre- and post- hemodialysis. However, studies of the cut-off values of NPs have yielded inconsistent results, such that further large-scale studies are needed to clarify these issues. This review summarizes the pathophysiology and significance of NPs in ESKD patients, especially their potential role as risk stratification biomarkers in clinical management.

Association of NT-proBNP and BNP With Future Clinical Outcomes in Patients With ESKD: A Systematic Review and Meta-analysis

RATIONALE & OBJECTIVE

Use of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) for cardiovascular (CV) risk assessment in patients with end-stage kidney disease (ESKD) remains unclear. We examined the associations between different threshold elevations of these peptide levels and clinical outcomes in patients with ESKD.

STUDY DESIGN

Systematic review and meta-analysis.

SETTING & STUDY POPULATIONS

We searched MEDLINE and EMBASE (through September 2019) for observational studies of adults with ESKD (estimated glomerular filtration rate≤15mL/min/1.73m² or receiving maintenance dialysis).

SELECTION CRITERIA FOR STUDIES

Studies that reported NT-proBNP or BNP levels and future CV events, CV mortality, or all-cause mortality.

DATA EXTRACTION

Cohort characteristics and measures of risk associated with study-specified peptide thresholds.

ANALYTICAL APPROACH

Hazard ratios (HRs) for clinical outcomes associated with different NT-proBNP and BNP ranges were categorized into common thresholds and pooled using random-effects meta-analysis.

RESULTS

We identified 61 studies for inclusion in our review (19,688 people). 49 provided sufficient detail for inclusion in meta-analysis. Pooled unadjusted HRs for CV mortality were progressively greater for greater thresholds of NT-proBNP, from 1.45 (95% CI, 0.91-2.32) for levels>2,000pg/mL to 5.95 (95% CI, 4.23-8.37) for levels>15,000pg/mL. Risk for all-cause mortality was significantly higher at all NT-proBNP thresholds ranging from> 1,000 to> 20,000pg/mL (HR range, 1.53-4.00). BNP levels>550pg/mL were associated with increased risk for CV mortality (HR, 2.54; 95% CI, 1.49-4.33), while the risks for all-cause mortality were 2.04 (95% CI, 0.82-5.12) at BNP levels>100pg/mL and 2.97 (95% CI, 2.21-3.98) at BNP levels>550pg/mL. Adjusted analyses demonstrated similarly greater risks for CV and all-cause mortality with greater NT-proBNP concentrations.

LIMITATIONS

Incomplete outcome reporting and risk for outcome reporting bias. Estimation of risk for CV events for specific thresholds of both peptides were limited by poor precision.

CONCLUSIONS

ESKD-specific NT-proBNP and BNP level thresholds of elevation are associated with increased risk for CV and all-cause mortality. This information may help guide interpretation of NT-proBNP and BNP levels in patients with ESKD.

Prognostic impact of galectin-3 in chronic kidney disease patients: a systematic review and meta-analysis

BACKGROUND

Galectin-3 as a β-galactoside-binding lectin, which has served important functions in numerous biological activities including cell growth, apoptosis, pre-mRNA splicing, differentiation, transformation, angiogenesis, inflammation, fibrosis, and host defense, may be used in prediction of clinical outcomes in CKD patients. However, the given results remain debatable and inconclusive. Hence, we performed a comprehensive meta-analysis to clarify the predictive value of galectin-3 in patients with CKD, especially ESRD patients going on dialysis.

METHODS

PubMed and Embase electronic databases were searched to identify eligible studies reporting the association between galectin-3 and adverse outcomes in CKD patients. We searched the literatures published October 2018 or earlier. We used both fix-effects and random-effects models to calculate the overall effect estimate. An I² > 50% indicates at least moderate statistical heterogeneity. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity.

RESULTS

We ultimately enrolled five studies with a total of 5226 patients in this meta-analysis. The result showed that high galectin-3 levels were associated with increased risk of all-cause mortality and cardiovascular (CV) events in CKD patients. For every 1% increased in galectin-3, the risk of all-cause mortality increased by 37.9% (HR 1.379, 95% CI 1.090-1.744). Much more, the risk of CV events in CKD patients was also significantly increased (HR 1.054, 95% CI 1.007-1.102) with no statistical heterogeneity among the studies (I² = 0.0%, p = 0.623). However, there was no statistical difference between the risk of all-cause mortality and galectin-3 in HD patients (HR 1.171, 95% CI 0.963-1.425).

CONCLUSIONS

Our meta-analysis suggests that high levels of galectin-3 may increase the risk of all-cause mortality and CV events in CKD patients, however, probably not a sensitive biomarker for outcomes in HD patients. Further studies were warranted to validate our findings.

Cardiac troponins in chronic kidney disease patients with special emphasis on their importance in acute coronary syndrome

Troponin measurement is one of crucial assessments facilitating diagnosis of acute coronary syndrome. Patients with chronic kidney disease are decimated by cardiovascular disease. Unfortunately, elevated concentration of serum troponin is commonly faced in clinical practice creating a challenge to rule out acute cardiac ischaemia in this vulnerable population. This review presents current knowlegde on analytical differences in troponin T and I measurements, their prognostic significance and their application in diagnosing acute coronary syndrome in chronic kidney disease patients. It also points out poorly known aspects and suggests directions for future research.

NT-proBNP in the Prognosis of Death or Need for Renal Replacement Therapy in Patients with Stage 3-5 Chronic Kidney Disease

BACKGROUND

The risk of cardiovascular (CV) complications is much greater in patients with chronic kidney disease (CKD). The aim of this study was to assess predictors of mortality, renal failure progression, and the need for dialysis in patients with CKD.

METHODS

The study group consisted of 70 patients with stage 3-5 CKD, followed up on average for 33.4 ± 15.6 months. Laboratory tests and echocardiography were performed on all patients. Composite endpoints were defined as (1) all-cause mortality and (2) mortality or renal replacement therapy (RRT), defined as the initiation of dialysis therapy.

RESULTS

During the observation period, 13 patients died and 11 began dialysis therapy. NT-proBNP was found to be a significant predictor in receiver operating characteristic curve analysis for all study endpoints. The optimal cutoff value for NT-proBNP as a predictor of mortality was 569.8 pg/mL, with a sensitivity of 53.8% and a specificity of 89.1%. For mortality or RRT, the cutoff value for NT-proBNP was 384.9 pg/mL, with a sensitivity and specificity of 70.8 and 72.7%, respectively. In a multivariate regression analysis, NT-proBNP was an independent predictor of mortality with an OR = 7.5 (95% CI: 1.05-53.87; p = 0.044) and of mortality or RRT with an OR = 4.7 (95% CI: 1.01-22.66; p = 0.048).

CONCLUSIONS

NT-proBNP is an independent predictor of mortality in patients with CKD and can also be useful for CV risk stratification in this patient population.

High-Sensitivity Troponin T and C-Reactive Protein Have Different Prognostic Values in Hemo- and Peritoneal Dialysis Populations: A Cohort Study

Background

Dialysis patients have an exceedingly high mortality rate. Biomarkers may be useful tools in risk stratification of this population. We evaluated the prognostic value of high‐sensitivity cardiac troponin T (hs‐cTnT) and CRP (C‐reactive protein) in predicting adverse outcomes in stable hemodialysis and peritoneal dialysis (PD) patients. Variability in hs‐cTnT was also examined.

Methods and Results

A retrospective cohort study included 574 dialysis patients (hemodialysis 347, PD 227). Outcomes examined included mortality and major adverse cardiovascular events, with median follow‐up of 3.5 years. hs‐cTnT was an independent predictor of both outcomes in hemodialysis and PD patients. Increased risk only became significant when hs‐cTnT reached quintile 3 (>49 ng/L). Area under the receiver operating curve analysis showed that the addition of hs‐cTnT to clinical parameters significantly improved its prognostic performance for mortality in PD patients (P=0.002). CRP was an independent predictor of both outcomes in PD patients only. Only CRP in the highest quintile (>16.8 mg/L) was associated with increased risk. hs‐cTnT remained relatively stable for the whole follow‐up period for hemodialysis patients, whereas for PD patients, hs‐cTnT increased by 23.63% in year 2 and 29.13% in year 3 compared with baseline (P<0.001).

Conclusions

hs‐cTnT and CRP are useful tools in predicting mortality and major adverse cardiovascular events in hemodialysis and PD patients. Given that hs‐cTnT levels increase over time in PD patients, interval monitoring may be valuable for risk assessment. In contrast, hs‐cTnT in hemodialysis patients has little interval change and progress monitoring is not indicated.

Predictive abilities of baseline measurements of fluid overload, assessed by bioimpedance spectroscopy and serum N-terminal pro-B-type natriuretic peptide, for mortality in hemodialysis patients

INTRODUCTION

Fluid overload is one of the most important, yet modifiable, risk factors associated with worse outcomes in hemodialysis (HD) patients. However, its precise assessment in clinical practice is still under investigation.

MATERIAL AND METHODS

This is an observational prospective study which included 285 stable patients with end-stage renal disease on standard thrice-weekly HD therapy. Overhydration was assessed by the combination of relative fluid overload (RFO), using bioimpedance spectroscopy, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The outcome of interest was all-cause mortality.

RESULTS

The median values for NT-proBNP and RFO were 4595 pg/ml and 6.9%, respectively. We divided the study population into four groups according to these median levels: group 1 - low NT-proBNP and low RFO; group 2 - high NT-proBNP and low RFO; group 3 - low NT-proBNP and high RFO; group 4 - high NT-proBNP and high RFO. During the follow-up (mean: 41.1, median: 48.7 months), 89 (31.2%) patients died. In the univariable Cox survival analysis only patients in group 4, and not those from group 2 or 3, had significantly higher HRs as compared to those in group 1 (HR = 1.5, 95% CI: 0.8-2.8, HR = 1.6, 95% CI: 0.8-2.9 and HR = 2.4, 95% CI: 1.3-4.2, for group 2, 3 and 4, respectively). Furthermore, these results were maintained in the multivariable Cox analysis.

CONCLUSIONS

Including both bioimpedance and NT-proBNP monitoring in a more comprehensive fluid status assessment could improve the diagnosis of fluid overload with a final improvement in patients' outcome.

B-Type Natriuretic Peptide and Cardiac Troponin I Are Associated With Adverse Outcomes in Stable Kidney Transplant Recipients

BACKGROUND

Approximately 200 000 kidney transplant recipients are living in the United States; they are at increased risk for cardiovascular and other adverse outcomes. Biomarkers predicting these outcomes are needed. Using specimens collected during the Folic Acid for Vascular Outcome Reduction in Transplantation trial, we determined whether plasma levels of B-type natriuretic peptide (BNP) and cardiac troponin I are associated with adverse outcomes in stable kidney transplant recipients.

METHODS

Five hundred ten subjects were selected randomly from the 4110 Folic Acid for Vascular Outcome Reduction in Transplantation participants. This cohort was then enriched for all additional subjects with adverse outcomes (death, dialysis-dependent kidney failure (DDKF), and cardiovascular outcomes) for a total of 1131 participants studied. Quartiles of BNP and high-sensitivity cardiac troponin I (hs-cTnI) were included in adjusted models. Combinations of normal and elevated hs-cTnI (>26.2 ng/L) and BNP (>100 pg/mL) were also studied.

RESULTS

Median concentrations (interquartile ranges) were 5.6 (3.3-10.5) ng/L for hs-cTnI and 39 (15, 94) pg/mL for BNP. Hazard ratios for each adverse outcome were higher with higher quartiles of BNP after adjustment and remained statistically significant after adding hs-cTnI to the model. The highest quartile hazard ratio for DDKF was 2.47 (95% confidence interval [95% CI], 1.21-5.05). Simultaneous elevations of BNP and hs-cTnI over clinical cutoffs were strongly associated with adverse outcomes with hazard ratios 8.8 (95% CI, 3.4-23.1) for DDKF and 6.3 (95% CI, 2.7-15.0) for cardiovascular outcomes.

CONCLUSIONS

Higher BNP is associated with mortality and cardiovascular and kidney outcomes in stable kidney transplant recipients. Elevated BNP and hs-cTnI identify candidates for targeted risk reduction.

Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study

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.

Heart Failure with Preserved and Reduced Ejection Fraction in Hemodialysis Patients: Prevalence, Disease Prediction and Prognosis

BACKGROUND/AIMS

Heart failure (HF) is a main cause of mortality of hemodialysis (HD) patients. While HF with reduced ejection fraction (HFrEF) is known to only affect a minority of patients, little is known about the prevalence, associations with clinical characteristics and prognosis of HF with preserved ejection fraction (HFpEF).

METHODS

We included 105 maintenance HD patients from the Medical University of Vienna into this prospective single-center cohort study and determined the prevalence of HFpEF (per the 2013 criteria of the European Society of Cardiology) and HFrEF (EF <45%), using standardized post-HD transthoracic echocardiography. We also assessed clinical, laboratory and volume status parameters (by bioimpedance spectroscopy). These parameters served to calculate prediction models for both disease entities, while clinical outcomes (frequency of cardiovascular hospitalizations and/or cardiac death) were assessed prospectively over 27±4 months of follow-up.

RESULTS

All but 4 patients (96%) had evidence of diastolic dysfunction. 70% of the entire cohort fulfilled HF criteria (81% HFpEF, 19% HFrEF). Age, female sex, body mass index, blood pressure and dialysis vintage were predictive of HFpEF (sensitivity 86%, specificity 63%; AUC 0.87), while age, female sex, NT pro-BNP, history of coronary artery disease and atrial fibrillation were predictive of HFrEF (sensitivity 85%, specificity 90%; AUC 0.95). Compared to patients without HF, those with HFpEF and HFrEF had a higher risk of hospitalization for cardiovascular reason and/or cardiac death (adjusted HR 4.31, 95% CI 0.46-40.03; adjusted HR 3.24, 95% CI 1.08-9.75, respectively).

CONCLUSION

Diastolic dysfunction and HFpEF are highly prevalent in HD patients while HFrEF only affects a minority. Distinct patient-specific characteristics predict diagnosis of either entity with good accuracy.

Incidence of sudden cardiac death in adults with end-stage renal disease: a systematic review and meta-analysis

BACKGROUND

Although sudden cardiac death (SCD) is recognized as a distinct cause of death in patients with end stage renal disease (ESRD), its incidence has not been well summarized.

METHODS

We performed a systematic review and meta-analysis of the literature based on a protocol developed a priori. We searched MEDLINE and EMBASE (inception to March 2015) for randomized controlled trials and cohort studies reporting the incidence of SCD in adult patients with ESRD on hemodialysis or peritoneal dialysis. We collected data on number of SCD as well as the definition of SCD for each individual study. A random-effects model was used to summarize the incidence of SCD. We conducted subgroup analyses to explore sources of heterogeneity.

RESULTS

Forty two studies (n = 80,382 patients) were included in the meta-analysis. The incidence of SCD among adults with ESRD ranged from 0.4 to 10.04 deaths per 100 person-years. The definitions and assessment of SCD varied across the included studies. There was evidence of significant heterogeneity (I(2) = 98; p < 0.001), which was not explained by subgroup analyses stratified by mean age, proportion of hypertensive or diabetic patients, follow-up time, study size, or type of cohort studied.

CONCLUSION

Current estimates of the incidence of SCD among adults with ESRD vary widely. There is a need for further studies to more accurately estimate the incidence of SCD in patients with ESRD.

Predictive Value for Galectin 3 and Cardiotrophin 1 in Hemodialysis Patients

Patients with end-stage renal disease (ESRD) have an increased risk of all-cause mortality. The prognostic value of the new cardiac biomarkers, cardiotrophin 1 (CT-1) and galectin 3 (GAL-3), has not yet been defined in hemodialysis (HD) patients. The aim of this study was to determine the use of these novel biomarkers for predicting mortality in HD patients. Plasma GAL-3 and CT-1 concentrations were determined (at baseline) in 88 HD patients followed for 22.2 ± 4.7 months. During the follow-up period, 21 (23.9%) deaths were recorded. According to Cox analysis, the cutoff point for GAL-3 as a predictor of mortality was 23.73 ng/mL, while the cutoff point for CT-1 as a predictor of mortality was 36 pg/mL. In univariate analysis, only GAL-3 >23.73 ng/mL was an independent predictor of mortality (hazard ratio 2.60; 95% confidence interval, 1.09-6.18). In a multivariable Cox proportional hazards model, GAL-3 levels above the cutoff value remained an independent predictor of all-cause mortality. Our data suggest that similar to the general population, GAL-3 is an independent predictor of mortality in HD patients.

The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients

Background

Maintaining optimal fluid balance is essential in haemodialysis (HD) patients but clinical evaluation remains problematic. Other technologies such as bioimpedance are emerging as valuable adjuncts. This study was undertaken to explore the potential utility of the natriuretic peptides – atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in the assessment of fluid status and cardiovascular risk in this setting.

Methods

This was a cross-sectional study carried out in an unselected cohort of 170 prevalent HD patients. Volume status was assessed by clinical parameters – the presence or absence of peripheral oedema, raised jugular venous pressure and basal lung crepitations; by extracellular fluid volume (ECFV) status determined by whole body bioimpedance; and by serum levels of BNP and ANP (pre- and post –dialysis). The relationships of ANP and BNP levels to clinical and bioimpedance parameters of volume status was determined. Patients were followed up for 5 years to assess the relationship of natriuretic peptide levels to mortality.

Results

Bioimpedance estimates of ECFV expansion (>105 % of ideal ECFV) was present in 52 % of patients pre-dialysis. A significant proportion (21 %) of pre-dialysis patients had a depleted ECFV (<95 % of ideal ECFV) pre-dialysis. The situation was reversed post-dialysis. A raised JVP >3 cm was the most reliable clinical sign of ECFV expansion inferred from bioimpedance measurements and natriuretic peptide levels. The vast majority of patients with this sign also had lung crepitations or peripheral oedema or both. BNP was a stronger predictor of ECFV expansion than either pre- or post-dialysis ANP. BNP was also a stronger predictor of five-year survival.

Conclusion

Serum levels of BNP have a strong relationship to both volume status and survival in HD patients. We found no clear role for measurement of ANP, though changes in blood levels may be a sensitive indicator of acute changes in volume status. Whether monitoring levels of these peptides has a role in the management of volume status and cardiovascular risk requires further study.

Vasoactive Peptide Levels after Change of Dialysis Mode

Background/Aims

Plasma concentrations of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) are increased in end-stage renal disease. Improvement in hemodynamic stability has been reported when switching from hemodialysis (HD) to on-line hemodiafiltration (ol-HDF). The aim of this study was to investigate plasma concentrations of NT-proBNP, BNP and neuropeptide Y (NPY) during a 1-year follow-up, after a change from high-flux HD to postdilution ol-HDF. Additional variables were also studied, e.g. pulse wave velocity and ordinary clinical parameters.

Method

We conducted a prospective, single-center study including 35 patients who were switched from HD to HDF. Plasma concentrations of NT-proBNP, BNP and NPY before and after dialysis were measured at baseline (i.e. HD) and at 1, 2, 4, 6 and 12 months on HDF.

Results

All three peptide levels decreased significantly during HD and HDF when comparing concentrations before and after dialysis. Mean absolute value (before/after) and relative decrease (%) before versus after dialysis was 13.697/9.497 ng/l (31%) for NT-proBNP, 62/40 ng/ml (35%) for BNP and 664/364 pg/l (45%) for NPY. No significant differences were observed when comparing predialysis values over time. However, postdialysis NT-proBNP concentration showed a significant decrease of 48% over time after the switch to HDF.

Conclusion

The postdialysis plasma levels of NT-proBNP, BNP and NPY decreased significantly during both dialysis modes when compared to before dialysis. The postdialysis lowering of NT-proBNP increased further over time after the switch to ol-HDF; the predialysis levels were unchanged, suggesting no effect on its production in the ventricles of the heart.