The Prognostic Role of Atrial Natriuretic Peptides in Hemodialysis Patients

Abstract

Background: It is well known that plasma atrial natriuretic peptide (ANP) is an indicator of extracellular fluid volume expansion and that plasma ANP is considered to be a marker for setting the proper dry weight of HD patients. Although the plasma ANP is a prognostic predictor of cardiac death, the prognostic role of ANP in HD patients has yet to be elucidated. In this study, we investigated the prognostic role of ANP in HD patients. Methods: Plasma ANP concentrations were measured in 105 HD patients after HD. Multiple regression analysis was performed to determine the major factors causing increased plasma ANP concentrations. Cardiac mortality was monitored for 24 months after baseline analysis, and the prognostic role of ANP was examined by Cox proportional hazards regression analysis. Results: Multiple regression analysis showed that cardiovascular disease (CD) and age were independent factors for elevated ANP (R² = 0.298, p < 0.0001). During a 24-month follow-up period, cardiac death occurred in 11 patients. Kaplan- Meier survival estimates of patients from varying plasma ANP levels (<50 and >50 pg/ml) differed between the two groups (p < 0.0001). The group with the higher ANP level (>50 pg/ml) had the lower survival. When compared with patients with ANP <50, the hazard ratios for cardiac death of patients with ANP of >50 pg/ml were 32.0 (95% confidence interval (CI) 4.1 to 252.4). Univariate Cox proportional hazards model showed that ANP, left ventricular ejection fraction (LVEF), LVMI, age, serum albumin and C-reactive protein (CRP) were significantly associated with the risk of cardiac mortality. By stepwise multivariate Cox proportional hazards analysis, only ANP, LVMI and CRP remained powerful independent predictors of cardiac death. The relative risk ratios were 3.483 (95% CI 1.640–7.397) for ln ANP, 1.023 (1.008–1.038) for LVMI, and 1.379 (1.115–1.705) for CRP. Conclusion: High plasma ANP level of post-HD were strongly associated with CD and age. Post-HD ANP level may be a reliable parameter for assessing the risk for cardiac death in HD patients by providing prognostic information independent of other variables previously reported.

The Association of Mid-Regional Pro-Adrenomedullin and Mid-Regional Pro-Atrial Natriuretic Peptide with Mortality in an Incident Dialysis Cohort

“…Our findings complement and extend previously reported cohort studies of end-stage renal disease for the biomarkers ANP [8]–[12] and ADM [13] (Table 5). Most of these studies were done in small cohorts and/or short observation periods and only one study considered ADM. Our cohort differs from these earlier studies since we investigated baseline levels in patients before first dialysis treatment.…”

“…Both hormones are elevated in the early stages of CKD [4], [5] and were shown to be highly predictive for progression of CKD in nondiabetic patients [6], [7]. Elevated levels of ANP [8]–[12] and ADM [13] have been reported to be associated with cardiac events, overall and cardiovascular mortality in patients already on dialysis. Increased levels of ANP and ADM have been associated with higher mortality rates in cohorts of cardiac patients as well as in patients with type 2 diabetes mellitus [14]–[17].…”

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

“…In addition, plasma natriuretic peptide concentrations are affected by the volume status [18], which varies particularly between the hemodialysis sessions. Still, plasma natriuretic peptide concentrations have proven to be a strong predictor of mortality in ESRD patients [4,19].…”

Relationship between Filtration Coefficients of Microvasculature and Levels of Atrial Natriuretic Peptide or Echocardiographic Measurements

“…It is well known that plasma ANP level is an indicator of extracellular fl uid volume expansion and that plasma ANP is considered to be a marker for setting the adequate DW of HD patients [20] . Osajima et al [21] reported that the ideal post-HD ANP level is approximately 50-60 pg/ ml in patients without cardiovascular disease.…”