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Observational Study
, 40 (1), 127-134

N-terminal-pro-B-type-natriuretic Peptide Associated With 2-year Mortality From Both Cardiovascular and Non-Cardiovascular Origins in Prevalent Chronic Hemodialysis Patients

Affiliations
Observational Study

N-terminal-pro-B-type-natriuretic Peptide Associated With 2-year Mortality From Both Cardiovascular and Non-Cardiovascular Origins in Prevalent Chronic Hemodialysis Patients

Chihiro Kawagoe et al. Ren Fail.

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; cardiovascular disease; chronic dialysis; infection; malignancy; prognosis.

Figures

Figure 1.
Figure 1.
Comparison between logarithmic NT-proBNP and other clinical parameters at baseline. Logarithmic NT-proBNP correlated with age (r = 0.31, p < .01) (A) and cardiothoracic ratio (r = 0.50, p < .01) (B), but not with hemodialysis vintage (r = 0.07, p = .012) (C), mean pre-dialysis systolic blood pressure (r = 0.15, p < .01) (D), or dry weight (r=-0.29, p < .01) (E). All data were extracted using Spearman’s rank correlation tests.
Figure 2.
Figure 2.
Receiver operating characteristic (ROC) curve for all causes of death and Kaplan–Meyer analysis. Sensitivity and specificity for all causes of death was assessed using the ROC curve (A). For the two-year all-cause mortality prediction, the area under the curve (AUC) was 0.761 and the cut-off point was 7400 ng/L. AUC for other causes of death were: 0.750 for CVD-related death, 0.702 for infection and malignancy-related death, and 0.745 for others and unknown cause of death. Using the cut-off point for all causes of death, the mortality rate was clearly and significantly divided into better and worse prognoses using the Kaplan–Meier method (all causes of death (B), cardiovascular-related death (C), infection and malignancy-related death (D), and others and unknown cause of death (E)). Gray line, NT-proBNP <7400 ng/L; black line, NT-proBNP ≥7400 ng/L.

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