N-Terminal Pro-B-type Natriuretic Peptide and Its Correlation to Haemodialysis-Induced Myocardial Stunning

Breidthardt, Tobias; Burton, James O.; Odudu, Aghogho; Eldehni, Mohamed Tarek; Jefferies, Helen J.; McIntyre, Christopher W.

doi:10.1159/000351190

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…The prevalence of dialysis-induced WMAs in our cohort is comparable with a recent study by Assa et al in which the prevalence of dialysis-induced WMAs was 27%, 3 18 In contrast to our data on hs-TnT, McIntyre's group found that troponin T, assayed with the fourth-generation troponin T assay, was associated with worsened WMA. 19 Notably, both the troponin T assay and the method of measuring WMAs were different in this prior cohort.…”

Section: Discussionsupporting

confidence: 87%

“…'s study include the association of low baseline ejection fraction with WMAs and the lack of association of intradialytic hemodynamic changes or ultrafiltration with development of WMAs. Similarly to our findings, McIntyre's group has shown that predialysis NT‐proBNP levels do not predict worsening WMAs in concurrent dialysis sessions . In contrast to our data on hs‐TnT, McIntyre's group found that troponin T, assayed with the fourth‐generation troponin T assay, was associated with worsened WMA .…”

Section: Discussionsupporting

confidence: 80%

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Determinants of hemodialysis‐induced segmental wall motion abnormalities

Dubin

Teerlink

Schiller

et al. 2013

Hemodialysis International

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Background Patients who demonstrate worsening of cardiac wall motion (WM) during hemodialysis have higher one-year mortality. We sought to identify risk factors for dialysis-induced WM abnormalities. Additionally, we examined the effects of hemodialysis on other parameters of cardiac function. Methods Forty patients underwent echocardiography directly before dialysis and during the last hour of dialysis (79 dialysis sessions). Candidate predictors for intradialytic worsening of WM included age, a history of heart failure (HF) or coronary artery disease, changes in blood pressure or heart rate, high sensitivity cardiac troponin T (hs-TnT) and N-terminal brain natriuretic peptide (NT-proBNP). Results Among 40 patients, WM worsened segmentally in 8 patients (20%), worsened globally in 1(3%), and improved segmentally in 4(10%). Diastolic function worsened in 44% of patients, and left ventricular ejection fraction was largely unchanged during dialysis. The case of globally worsened WM occurred in the setting of intradialytic hypertension in a patient without heart failure. Surprisingly, history of coronary artery disease, hemodynamics, and serologic factors were not associated with worsened segmental WM during dialysis. After adjustment for history of coronary artery disease and other cardiac risk factors, patients with a history of HF had a 3-fold higher risk of worsening segmental WM during dialysis (RR 3.1, 95%CI [1.1, 9], p=0.04). Conclusions In conclusion, patients with a history of clinical HF were at higher risk of intradialytic worsening of segmental WM. Further studies are needed to determine the mechanism of this association and whether cardioprotective medications could ameliorate this adverse cardiac effect of hemodialysis.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 80%

Determinants of hemodialysis‐induced segmental wall motion abnormalities

Dubin

Teerlink

Schiller

et al. 2013

Hemodialysis International

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“…Therefore we measured novel biomarkers in cardiac healthy patients with CKD5D, e.g. copeptin [9–16], MR-proANP [17, 18], NT-proBNP [19–25] and non-invasive ultrasound parameters, i.e. oscillation of the diameter of the vena cava inferior and echocardiographic parameters, before and after HD.…”

Section: Introductionmentioning

confidence: 99%

Modern peptide biomarkers and echocardiography in cardiac healthy haemodialysis patients

et al. 2017

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BackgroundIn this prospective study, we aimed to assess the haemodynamic changes before and after haemodialysis (HD) in cardiac healthy subjects on chronic HD by imaging methods and endocrine markers of fluid balance.MethodsMid-regional pro-atrial natriuretic peptide (MR-proANP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), vasopressin (AVP) and copeptin (CT-proAVP), metanephrines and normetanephrines, renin and aldosterone, standard transthoracic echocardiography and diameter of vena cava inferior (VCID) were performed in 20 patients with end stage renal disease (CKD5D) before and after HD and were stratified in residual excretion (RE, less or more 0.5 l) and ultrafiltration rate (UF, less or more 2 l).ResultsCopeptin was significantly higher in patients before HD. Copeptin was inversely correlated with haemodialysis treatment adequacy (KT/v), RE and UF, but was not significantly influenced by age, gender and body mass index (BMI). MR-proANP was significantly reduced by haemodialysis by 27% and was inversely correlated with KT/v, but there was a significant influence by UF, RE, age, gender and BMI. NT-proBNP was significantly higher in patients before HD and was not influenced by RE and UF. Renin, aldosterone, metanephrines and normetanephrines did not demonstrate significant differences. Echocardiographic parameters and VCID were significantly correlated with RE, UF and copeptin.ConclusionModern biomarkers will provide cardiovascular risk assessment, but elimination (UF), RE and other factors may influence the serum concentrations, e.g. in patients with renal impairment. The interpretation will be limited by altered reference ranges, and will be restricted to individual courses combined with clinical and echocardiographic data.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0589-3) contains supplementary material, which is available to authorized users.

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“…NTproBNP is a marker of myocardial stretch and correlates with reduced left ventricular function and volume overload in dialysis patients [ 3 , 16 , 17 ]. A number of previous studies have reported the association between elevated NTproBNP and cTnI and all-cause and cardiovascular mortality [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study

Kruzan

Herzog

et al. 2016

BMC Nephrol

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BackgroundSudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP) troponin I (cTnI) in hemodialysis patients.MethodsWe measured NTproBNP and cTnI in 503 hemodialysis patients of a national prospective cohort study. We determined their association with SCD using Cox regression, adjusting for demographics, co-morbidities, and clinical factors and risk prediction using C-statistic and Net Reclassification Improvement (NRI).ResultsPatients’ mean age was 58 years and 54 % were male. During follow-up (median 3.5 years), there were 75 outpatient SCD events. In unadjusted and fully-adjusted models, NTproBNP had a significant association with the risk of SCD. Analyzed as a continuous variable, the risk of SCD increased 27 % with each 2-fold increase in NTproBNP (HR, 1.27 per doubling; 95 % CI, 1.13–1.43; p < 0.001). In categorical models, the risk of SCD was 3-fold higher in the highest tertile of NTproBNP (>7,350 pg/mL) compared with the lowest tertile (<1,710 pg/mL; HR for the highest tertile, 3.03; 95 % CI, 1.56–5.89; p = 0.001). Higher cTnI showed a trend towards increased risk of SCD in fully adjusted models, but was not statistically significant (HR, 1.17 per doubling; 95 % CI, 0.98–1.40; p = 0.08). Sensitivity analyses using competing risk models showed similar results. Improvement in risk prediction by adding cardiac biomarkers to conventional risk factors was greater with NTproBNP (C-statistic for 3-year risk: 0.810; 95 % CI, 0.757 to 0.864; and continuous NRI: 0.270; 95 % CI, 0.046 to 0.495) than with cTnI.ConclusionsNTproBNP is associated with the risk of SCD in hemodialysis patients. Further research is needed to determine if biomarkers measurement can guide SCD risk prevention strategies in dialysis patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0230-x) contains supplementary material, which is available to authorized users.

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N-Terminal Pro-B-type Natriuretic Peptide and Its Correlation to Haemodialysis-Induced Myocardial Stunning

Cited by 6 publications

References 20 publications

Determinants of hemodialysis‐induced segmental wall motion abnormalities

Determinants of hemodialysis‐induced segmental wall motion abnormalities

Modern peptide biomarkers and echocardiography in cardiac healthy haemodialysis patients

Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study

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