N-Terminal Pro-Brain Natriuretic Peptide as a Predictor of Heart Failure with Preserved Ejection Fraction in Hemodialysis Patients without Fluid Overload

Kamano, Chisako; Osawa, Hirokazu; Hashimoto, Kazumasa; Nishimura, Shungo; Saito, S; Kashiwagi, Tetsuya; Iino, Yuichi; Katayama, Yasuo

doi:10.1159/000333841

Cited by 15 publications

(15 citation statements)

References 51 publications

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“…Additionally, strongly elevated NT pro-BNP levels were not associated with HFpEF, but only with HFrEF diagnosis. This result stands in contrast with an analysis by Kamano et al, who used NT pro-BNP levels as a predictive marker for diastolic dysfunction and HFpEF in HD [28]. According to our results, NT pro-BNP should only be applied for the exclusion of HFrEF, but cannot help in distinguishing HFpEF patients from those without HF.…”

Section: Discussioncontrasting

confidence: 99%

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

Antlanger¹,

Aschauer

Kopecky³

et al. 2017

Kidney Blood Press Res

1,913

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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.

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Section: Discussioncontrasting

confidence: 99%

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

Antlanger¹,

Aschauer

Kopecky³

et al. 2017

Kidney Blood Press Res

1,913

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“…Systolic left ventricular function served as a surrogate for cardiac status and still showed a high correlation to the plasma natriuretic peptide concentration. Other cardiac morbidities, such as diastolic function [16], valvular disease or rhythm disturbances, might also contribute to elevations in natriuretic peptide concentration, but were not entered into the model. Again it should be emphasized that association studies cannot prove causality between the studied parameters and elevated plasma natriuretic peptide concentrations and cannot distinguish between cause and consequence.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with end-stage renal disease, largely elevated plasma natriuretic peptide concentrations are difficult to interpret due to possibly reduced renal clearance and accumulation on the one hand and a high prevalence of cardiac disease and heart failure, even in the in the presence of preserved ejection fraction, on the other [16,17]. In addition, plasma natriuretic peptide concentrations are affected by the volume status [18], which varies particularly between the hemodialysis sessions.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Diagnostic Performance of Three Natriuretic Peptides in Hemodialysis Patients: Which is the Appropriate Biomarker?

Artunc

Müeller²,

Breidthardt³

et al. 2012

Kidney Blood Press Res

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Background: Plasma concentrations of natriuretic peptides are often elevated in chronic hemodialysis patients and difficult to interpret due to accumulation, high incidence of cardiac disease and changes in volume status. Mid-regional pro-ANP is a newly developed assay whereas BNP and its fragment NT-pro-BNP are available for a longer time. In this cross-sectional study, we compared the plasma concentration of MR-pro-ANP, BNP and NT-pro-BNP in stable ambulatory hemodialysis patients (n = 239) and investigated their associations with clinical factors such as residual diuresis, cardiac status and interdialytic weight gain and with mortality. Methods and Results: In all patients enrolled, the plasma concentration of all natriuretic peptides were largely elevated with a median concentration of 337 pg/ml (interquartile range 146-684) for BNP, 4435 pg/ml (1687-16228) for NT-proBNP and 907 pmol/L (650-1298) for MR-pro-ANP. Plasma concentration of all natriuretic peptides correlated independently with age, degree of systolic dysfunction and negatively with residual diuresis. Dependency on residual renal clearance was strongest for the fragments MR-pro-ANP and NT-pro-BNP. The plasma concentration of all natriuretic peptides was associated with mortality within 2 years of follow-up. Receiver-operated curves revealed a low sensitivity (32-45%), but high specificity for all natriuretic peptides (85-93%) resulting in a high negative predictive (82-87%). Best cut-off values obtained from were 18 611 pg/ml for NT-pro-BNP, 958 pg/ml for BNP and 1684 pmol/L for MR-pro-ANP. Conclusions: In hemodialysis patients, the fragments NTproBNP and MR-pro-ANP are largely elevated compared to BNP which is explained by accumulation. The prognostic performance of MR-pro-ANP is similar to that of NT-pro-BNP or BNP.

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“…This could offer an explanation for the finding of elevated NT-proBNP in patients with PEW. Previous studies have not established if it is possible to use NT-proBNP to distinguish fluid overload from left ventricular dysfunction in dialysis patients [25,36,37,38,39]. …”

Section: Discussionmentioning

confidence: 99%

Determinants of N-Terminal Pro-Brain Natriuretic Peptide Variation in Hemodialysis Patients and Prediction of Survival

Snaedal¹,

Qureshi

Carrero

et al. 2014

Blood Purif

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Background/Aims: N-Terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor of cardiac events and death in the general population and in chronic kidney disease. There is limited information on how natriuretic peptides vary in dialysis patients. The aim of this study was to analyze NT-proBNP variability, factors predicting its variability and survival related to NT-proBNP variability. Methods: A prospective 3-month observational study of prevalent hemodialysis patients with monthly measurements of NT-proBNP was carried out. A total of 211 hemodialysis patients were included, and mortality was recorded during 52 months of follow-up. Results: Inflammation was the strongest predictor of NT-proBNP variability. Patients with constantly high NT-proBNP had an increased risk of death adjusting for age, sex, dialysis vintage and comorbidity but not when also adjusting for nutritional status. Conclusions: Longitudinal changes in NT-proBNP are associated with changes in inflammation, nutritional status, age and comorbidity. Due to strong interactions with predictors of mortality such as nutritional status, we were unable to confirm NT-proBNP as an independent marker for mortality in dialysis patients.

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N-Terminal Pro-Brain Natriuretic Peptide as a Predictor of Heart Failure with Preserved Ejection Fraction in Hemodialysis Patients without Fluid Overload

Cited by 15 publications

References 51 publications

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

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

Comparison of the Diagnostic Performance of Three Natriuretic Peptides in Hemodialysis Patients: Which is the Appropriate Biomarker?

Determinants of N-Terminal Pro-Brain Natriuretic Peptide Variation in Hemodialysis Patients and Prediction of Survival

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