Brain Natriuretic Peptide between Traditional and Nontraditional Risk Factors in Hemodialysis Patients: Analysis of Cardiovascular Mortality in a Two-Year Follow-Up

Selim, Gjulsen; Stojceva-Taneva, Olivera; Spasovski, Goce; Georgievska-Ismail, Ljubica; Zafirovska-Ivanovska, Beti; Gelev, Saso; Dzekova, Pavlina; Trajcevska, L.; Trojacanec-Piponska, Sonja; Sikole, A.

doi:10.1159/000327615

Cited by 5 publications

(3 citation statements)

References 80 publications

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“…Twenty-seven relevant studies reporting on 8,666 individuals were identified from 16 countries. Thirteen studies were based in Europe [4] , [7] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , 5 in North America [5] , [26] , [27] , [28] , [29] , [30] , 2 in Australia [31] , [32] and and 6 in East Asia [6] , [33] , [34] , [35] , [36] , [37] . From all primary studies, over 63.4% of patients were receiving hemodialysis (HD).…”

Section: Resultsmentioning

confidence: 99%

B-Type Natriuretic Peptide and Prognosis of End-Stage Renal Disease: A Meta-Analysis

et al. 2013

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BackgroundThe prognostic importance of B-type natriuretic peptide (BNP) or N-terminal pro BNP (NT-proBNP) in patients with end-stage renal disease (ESRD) remains controversial.Methodology/Principal FindingsWe conducted an unrestricted search from the MEDLINE and EMBASE in all languages that were published between 1966 and Augest2013. Twenty-seven long-term prospective studies met our inclusion criterias. From the pooled analysis, elevated BNP/NT-proBNP was significantly associated with increased all cause mortality [odds ratio (OR), 3.85; 95% CI, 3.11 to 4.75], cardiovascular mortality (OR, 4.05; 95% CI, 2.53 to 6.84), and cardiovascular events (OR, 7.02; 95% CI, 2.21 to 22.33). The funnel plot showed no evidence of publication bias. The corresponding pooled positive and negative likelihood ratio for prediction of all cause mortality were 1.86 (95% CI, 1.66 to 2.08) and 0.48 (95% CI, 0.42 to 0.55), respectively.Conclusions/SignificanceBNP/NT-proBNP is a promising prognostic tool to risk-stratify the patients with ESRD. Further investigations are warranted to elucidate the specific pathogenic mechanisms and the impact of other potential prognostic factors.

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Section: Resultsmentioning

confidence: 99%

B-Type Natriuretic Peptide and Prognosis of End-Stage Renal Disease: A Meta-Analysis

et al. 2013

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“…However, none of the patients of the study had any sign of heart failure. Additionally, BNP measures in dialysis patients with echocardiographically diagnosed heart failure were more than 5 times higher than in our population [42] and BNP levels in our population are within a range that was identified as beneficial in a prospective 2-year mortality analysis [43]. …”

Section: Discussionmentioning

confidence: 92%

Association between autonomic nervous dysfunction and cellular inflammation in end-stage renal disease

Seibert

Zohles

Ulrich

et al. 2016

BMC Cardiovasc Disord

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BackgroundAlterations in autonomic nervous function are common in hemodialysis (HD) patients. Sympathetic as well as parasympathetic activation may be associated with immune and inflammatory responses. We intended to confirm a role of autonomous dysregulation for inflammation in HD patients.Methods30 HD patients (including 15 diabetics) and 15 healthy controls were studied for heart rate variability (HRV) using 5 min ECG recordings. Heart rate variability was estimated by time-domain parameters (the standard deviation of the RR intervals (SDNN) and the percentage of pairs of adjacent RR intervals differing by >50 ms (pNN50)) and frequency-domain-analysis (high- and low-frequency variation of RR intervals, HF and LF). Inflammation was detected as serum C-reactive Protein (CRP), IL-6 and circulating monocyte subpopulation numbers. Immune cells were characterized by ACh receptor expression.ResultsPatients differed from controls in terms of age (68.0 [14.8] yrs vs. 58.0 [13.0] yrs, p < 0.001; Median [IQR]) and sex. However, HRV parameters were different in controls and HD patients (SDNN controls 34.0 [14.0] ms, HD patients 15.5 [14.8] ms, p < 0.01). This finding was not restricted to patients with diabetes mellitus (diab), although diabetes is an important cause of autonomous dysfunction (SDNN, diab 13.0 [14.0] ms, non-diab 18.0 [15.3] ms, p = 0.8). LF and HF were reduced by the same magnitude to 1/3 of those in controls. Patients suffered from chronic inflammation (CRP 9.4 [12.9] mg/l, controls 1.6 [2.4] mg/l, p < 0.001) and expanded proinflammatory monocyte subpopulations (CD14++/CD16+ cells: patients 41 [27]/μl, controls 24 [18]/μl, p < 0.01). ECG parameters did not correlate with inflammation in patients, but monocyte ACh receptor expression was enhanced, indicating potentially elevated responsiveness of this cell type to parasympathetic regulation.ConclusionsHD patients have strongly impaired HRV. Chronic inflammation is not related to autonomous dysfunction, although monocytes express the ACh receptor at enhanced density making them potentially more sensitive to parasympathetic effects.Trial registrationThis study was listed with ClinicalTrials.gov (NCT00878033).Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0385-1) contains supplementary material, which is available to authorized users.

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“…In a 5-year cohort study of more than 88,000 MHD patients in the United States conducted by Jessica E Miller et al, it had been reported that the greatest survival gain of higher HD dose was associated with a Kt/V approaching the 1.6 to 1.8 range 16 . In contrast, several studies had shown that increasing dialysis dose has no effect on survival gain and no predictive effect on cardiovascular death 17 – 19 . The hemodialysis (HEMO) study compared the outcomes of patients at high dialysis doses (target spKt/V approximately 1.65) with those at standard dialysis doses (target spKt/V approximately 1.25) and showed no significant differences in all-cause and cardiovascular deaths 20 .…”

Section: Introductionmentioning

confidence: 98%

The association between dose of hemodialysis and patients mortality in a prospective cohort study

Liu

Wang

Zhang

et al. 2022

Sci Rep

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Dialysis adequacy is a known risk factor for mortality in maintenance hemodialysis (MHD) patients. However, the optimal dialysis dose remains controversial. Therefore, we aimed to explore the relationship between dialysis dose and all-cause and cardiovascular disease (CVD) mortality among MHD. We examined the associations of dialysis dose with mortality in a cohort (n = 558) of MHD patients from 31 December 2015 to 31 December 2020. Dialysis adequacy was assessed using baseline Single-pool Kt/Vurea (spKt/V), which was categorized into three groups, and the lowest dose group was used as the reference category. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. A total of 214 patients died (64.5% for CVD). Compared with the low-dose group, high-dose group could reduce the risk of all-cause mortality by 33% (HR = 0.67, 95% CI: 0.47–0.98). Of note, when stratification by age, high-dose group was associated with both lower all-cause (HR = 0.46, 95% CI: 0.26–0.81) and CVD mortality (HR = 0.42, 95% CI: 0.20–0.88) among patients with age below 65 years. When stratification by dialysis age, high-dose group was associated with decreased risk of CVD mortality (HR = 0.43, 95% CI: 0.20–0.91) among patients with dialysis age over 60 months. spKt/V is a simple index of hemodialysis dose used in clinical practice and a useful modifiable factor in predicting the risk of death, especially in MHD patients under 65 years old or dialysis age more than 60 months.

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Brain Natriuretic Peptide between Traditional and Nontraditional Risk Factors in Hemodialysis Patients: Analysis of Cardiovascular Mortality in a Two-Year Follow-Up

Cited by 5 publications

References 80 publications

B-Type Natriuretic Peptide and Prognosis of End-Stage Renal Disease: A Meta-Analysis

B-Type Natriuretic Peptide and Prognosis of End-Stage Renal Disease: A Meta-Analysis

Association between autonomic nervous dysfunction and cellular inflammation in end-stage renal disease

The association between dose of hemodialysis and patients mortality in a prospective cohort study

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