NT-proBNP and cardiovascular events in hemodialysis patients

• Sedov Dmitriy S.
• Fedotov Eduard A.
• Rebrov Andrey P.

Abstract

The aim was to estimate link of the N-terminal (NT)-pro hormone B-type natriuretic peptide (NT-proBNP) and cardiovascular events in hemodialysis patients.

Material and methods. Patients over the age of 18 with an end-stage renal disease (ESRD) on maintenance haemodialysis (HD) were enrolled (n=80) in this study. NT-proBNP serum levels were measured for all patients by enzyme-linked immunosorbent assay (ELISA) in addition to traditional clinical and biochemical studies. Transthoracic echocardiography were performed in 63 patients on HD. Results. The median of the NT-proBNP serum level was 2114.6 [1095; 4016] pg/ml. This value was slightly higher in men reaching 2143.5 [1087.6; 13750.7] pg/ml while the figure for women was 2044.3 [1095; 2572] pg/ml. The correlation between NT-proBNP levels and cardiovascular risk factors including dismal outcome for the long-term hemodialysis patients was analysed using Spearman's rank correlation method. As a result, a direct correlation was found between NT-proBNP levels and factors including age, number of years on dialysis, markers of systemic inflammation, volumetric echocardiographic parameters, average weekly post-dialysis hyperhydration, and values of the systolic pressure in the pulmonary artery. While correlation analysis has demonstrated inverse correlation with the parameters of nutritional status (body mass index, figures of triglycerides, hemoglobin, serum albumin) and the magnitude of the aortic valve opening during systole. A significant increase in the NT-proBNP levels was found (p=0.002) in hemodialysis patients with new cardiovascular events. In contrast, no differences in the values of NT-proBNP were detected in patients with cardiovascular diseases at the pre-dialysis stages of chronic kidney disease (CKD) (p>0.05). There were no significant differences in the level of NT-proBNP in groups with fatal and non-fatal cardiovascular events in patients on HD.

Conclusion. The serum level ofthe NT-proBNP in hemodialysis patients is significantly higher compared to the average population values. The link of NT-proBNP levels with traditional parameters of cardiovascular risk factors including dismal outcome in patients using the long-term HD, a significant increase in the level of NT-proBNP in patients with cardiovascular events that developed after the start of renal replacement therapy, allow the values of the NT-proBNP to be considered as a marker of cardiovascular events and dismal outcome in patients on HD. According to this study, the postponed cardiovascular events in the pre-dialysis stages of CKD are not associated with an increase in the level of NT-proBNP in hemodialysis patients. The absence of significant differences in the level of NT-proBNP in groups with fatal and non-fatal cardiovascular events is probably due to the small sample size.

Keywords:chronic kidney disease, end-stage renal disease, hemodialysis, NT-proBNP, cardiovascular risk, cardiovascular diseases

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)