N-Terminal Pro-Brain Natriuretic Peptide

Abstract

This study was performed to determine whether the N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a useful biomarker in predicting cardiovascular congestion, mortality, and cardiovascular death and event in chronic peritoneal dialysis (PD) patients. A prospective cohort study was conducted in 230 chronic PD patients in a dialysis unit of a university teaching hospital. Serum NT-pro-BNP was measured at baseline together with echocardiography and dialysis indices. Each patient was followed for 3 yr from the day of enrollment or until death. Time to develop first episode of cardiovascular congestion and other cardiovascular event and time to mortality and cardiovascular death were studied in relation to NT-pro-BNP. NT-pro-BNP showed the strongest correlation with residual GFR, followed by left ventricular ejection fraction and left ventricular mass index. In the univariate Cox regression model, NT-pro-BNP was a significant predictor of cardiovascular congestion, mortality, and cardiovascular death and event. In the fully adjusted multivariable Cox regression analysis that included residual GFR, left ventricular ejection fraction, and left ventricular mass index, the hazard ratios for cardiovascular congestion, mortality, composite end point of mortality and cardiovascular congestion, and cardiovascular death and event for patients of the fourth quartile were 4.25 (95% confidence interval [CI] 1.56 to 11.62; P ‫؍‬ 0.005), 4.97 (95% CI 1.35 to 18.28; P ‫؍‬ 0.016), 5.03 (95% CI 2.07 to 12.26; P < 0.001), 7.50 (95% CI 1.36 to 41.39; P ‫؍‬ 0.021), and 9.10 (95% CI 2.46 to 33.67; P ‫؍‬ 0.001), respectively, compared with the first quartile. These data showed that NT-pro-BNP is an important risk predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in chronic PD patients and adds important prognostic information beyond that contributed by left ventricular hypertrophy, systolic dysfunction, and other conventional risk factors.

Predictive Value of Brain Natriuretic Peptides in Patients on Peritoneal Dialysis

“…Wang et al showed that NT-proBNP is an important risk predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in chronic PD patients and adds important prognostic information beyond that contributed by left ventricular hypertrophy, systolic dysfunction, and other conventional risk factors (12). In the study presented here, we found that NT-proBNP was an independent predictor of allcause mortality as well as cardiovascular mortality.…”

“…ANP and particularly BNP levels are linked independently to left ventricular mass (3-5,8 -16) and function (3,6 -17) and predict total and cardiovascular mortality (1,3,8,10,12,18,40). This The values for peritoneal ultrafiltration represent the lowest quintile of the time-dependent analysis.…”

“…Prior investigations have identified plasma BNP and NT-proBNP levels as independent predictors of mortality or cardiovascular events in populations with chronic heart failure (45,46), acute coronary syndromes (47,48), prior myocardial infarction (49,50), established vascular disease or elevated coronary risk (51,52), stable coronary heart disease (53), and in community-based samples (54,55). Evaluations in patients on PD have been limited by small numbers (3,9,11,12,15,24 -26) and only one examined correlation between natriuretic peptide levels and outcomes (12).…”

“…Atrial natriuretic peptide (ANP) and particularly brain natriuretic peptide (BNP) levels are linked independently to left ventricular mass (3-5,8 -16) and function (3,6 -17) and predict total and cardiovascular mortality (1,3,8,10,12,18) as well as cardiac events (12,19). ANP and BNP decrease significantly during hemodialysis treatment but increase again during the interdialytic interval (1,2,4,6,7,14,17,20 -23).…”

“…Cardiac natriuretic peptides are increasingly considered to fulfill this role in nonrenal patients. Evaluations of cardiac natriuretic peptides in patients on PD have been limited by small numbers (3,9,11,12,15,24 -26) and only one study examined correlations between natriuretic peptide levels and outcomes (12). The PD population enrolled in the ADEMEX trial offered us the opportunity to evaluate cardiac natriuretic peptides and their value in predicting outcomes in the largest clinical trial ever performed on PD (29,30).…”