NT-pro BNP level at dialysis initiation is a useful biomarker for predicting hospitalization for ischemic heart disease

Clin Exp Nephrol. 2024 May;28(5):457-464. doi: 10.1007/s10157-023-02442-x. Epub 2024 Jan 19.


Background: Patients with end-stage kidney disease (ESKD) are at high risk of cardiovascular disease including stroke, heart failure, and ischemic heart disease (IHD). To prevent the occurrence and progression of CVD, a reliable prognostic cardiac biomarker is essential. We investigated the prognostic value of NT-proBNP for each incident type of CVD.

Methods: Male patients from the Ibaraki Dialysis Initiation Cohort (iDIC) study with preserved serum samples from dialysis initiation day (n = 212) were analyzed. Patients were classified into four groups according to quartiles of baseline NT-pro BNP levels. The relationship between NT-proBNP levels at the initiation of dialysis and the subsequent incidence of hospitalization events due to IHD, heart failure, and stroke was analyzed.

Results: The incidence rate for hospitalization due to IHD was significantly higher in the highest NT-proBNP category (Log rank p = 0.008); those of stroke and heart failure showed no significant differences among quartiles. Cox proportional hazards regression analysis revealed that serum NT-proBNT was the only prognostic factor for hospitalization for IHD after adjustment by major known IHD risk factors. (HR, 1.008; 95% confidence interval, 1.002-1.014; p = 0.01) The ROC curve analysis for the incidence of hospitalization due to IHD showed that NT-proBNP had an area under the curve (AUC) of 0.759 (95% CI 0.622-0.897; p = 0.004) at a cut-off value of 956.6 pg/mL.

Conclusion: NT-proBNP measurement at the initiation of dialysis therapy is useful to predict later hospitalization for IHD.

Trial registration: UMIN000010806.

Keywords: Dialysis; Hospitalization; Ischemic heart disease; NT-proBNP.

MeSH terms

  • Aged
  • Biomarkers* / blood
  • Heart Failure / blood
  • Heart Failure / epidemiology
  • Heart Failure / therapy
  • Hospitalization*
  • Humans
  • Incidence
  • Japan / epidemiology
  • Kidney Failure, Chronic* / blood
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / therapy
  • Male
  • Middle Aged
  • Myocardial Ischemia* / blood
  • Myocardial Ischemia* / diagnosis
  • Myocardial Ischemia* / epidemiology
  • Natriuretic Peptide, Brain* / blood
  • Peptide Fragments* / blood
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • ROC Curve
  • Renal Dialysis*
  • Stroke / blood
  • Stroke / epidemiology


  • Natriuretic Peptide, Brain
  • pro-brain natriuretic peptide (1-76)
  • Biomarkers
  • Peptide Fragments