N-terminal-pro-B-type-natriuretic peptide associated with 2-year mortality from both cardiovascular and non-cardiovascular origins in prevalent chronic hemodialysis patients

Abstract

N-terminal-pro-B-type-natriuretic peptide (NT-proBNP) was a predictive marker of cardiovascular disease (CVD)-related death in chronic dialysis patients. NT-proBNP was also correlated with markers of inflammation, malnutrition and protein-energy wasting. We hypothesized whether NT-proBNP was also associated with non-CVD death in chronic dialysis patients. A prospective observational study for incidence of death in chronic dialysis patients was conducted. Prevalent chronic dialysis patients (n = 1310) were enrolled and followed for 24 months. One hundred forty-four deaths were recorded. Area under the curve using ROC analysis for NT-proBNP showed: all causes of death (0.761), CVD-related (0.750), infection and malignancy-related (0.702) and others and unknown (0.745). After adjusting for age, sex, hemodialysis vintage, cardiothoracic ratio, mean pre-dialysis systolic blood pressure, dry weight and basal kidney disease, the hazard ratios (95% confidence intervals) per 1-log NT-proBNP calculated using multivariate Cox analysis were: all causes of death, 3.83 (2.51–5.85); CVD-related, 4.30 (2.12–8.75); infection and malignancy-related, 2.41 (1.17-4.93); and others and unknown origin, 5.63 (2.57–12.37). NT-proBNP was significantly associated not only with CVD-relate but also with non-CVD-related deaths in this population of prevalent chronic dialysis patients.

Keywords:

• N-terminal-pro-B-type-natriuretic peptide
• prognosis
• chronic dialysis
• cardiovascular disease
• infection
• malignancy

Acknowledgements

Research idea and study design: CK and YS; writing manuscript: CK and YS; data collection: YS, TT, HN, YY, AF, and SI; data analysis: CK and YS; supervision: SF.

We appreciate the help of the following attending physicians for their participation in the study by collecting data and providing useful suggestions: Y. Yamamoto, O. Wakisaka, T. Tanaka, H. Ebihara, M. Kuroki, M. Yamashita, J. Miyata, K. Aso, H. Ochiai, S. Hisanaga, S. Morita, F. Iemura, T. Uchida, N. Yokota, F. Sawano, M. Kawamura, H. Washimine, T. Ishihara, N. Ueno, H. Kinoshita, F. Matsuoka, K. Yamada, K. Fukudome, H. Inagaki, K. Hidaka, M. Kuboyama, A. Baba, S. Sonoda, R. Nishizono and F. Ebihara.

Disclosure statement

No potential conflict of interest was reported by the authors.