脑钠肽对腹膜透析患者的预测价值：来自ADEMEX试验的结果。
Predictive value of brain natriuretic peptides in patients on peritoneal dialysis: results from the ADEMEX trial.
作者信息
Paniagua Ramon, Amato Dante, Mujais Salim, Vonesh Edward, Ramos Alfonso, Correa-Rotter Ricardo, Horl Walter H
机构信息
Mexican Nephrology Collaborative Study Group, Unidad de Investigacioñ Médica en Enfermedades Nefrolìicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
出版信息
Clin J Am Soc Nephrol. 2008 Mar;3(2):407-15. doi: 10.2215/CJN.03820907. Epub 2008 Jan 16.
BACKGROUND AND OBJECTIVES
Natriuretic peptides have been suggested to be of value in risk stratification in dialysis patients. Data in patients on peritoneal dialysis remain limited.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients of the ADEMEX trial (ADEquacy of peritoneal dialysis in MEXico) were randomized to a control group [standard 4 x 2L continuous ambulatory peritoneal dialysis (CAPD); n = 484] and an intervention group (CAPD with a target creatinine clearance > or =60 L/wk/1.73 m(2); n = 481). Natriuretic peptides were measured at baseline and correlated with other parameters as well as evaluated for effects on patient outcomes.
RESULTS
Control group and intervention group were comparable at baseline with respect to all measured parameters. Baseline values of natriuretic peptides were elevated and correlated significantly with levels of residual renal function but not with body size or diabetes. Baseline values of N-terminal fragment of B-type natriuretic peptide (NT-proBNP) but not proANP(1-30), proANP(31-67), or proANP(1-98) were independently highly predictive of overall survival and cardiovascular mortality. Volume removal was also significantly correlated with patient survival.
CONCLUSIONS
NT-proBNP have a significant predictive value for survival of CAPD patients and may be of value in guiding risk stratification and potentially targeted therapeutic interventions.
背景与目的
利钠肽已被证明在透析患者的风险分层中具有重要价值。然而，关于腹膜透析患者的相关数据仍然有限。
设计、地点、参与者与测量方法：ADEMEX试验（墨西哥腹膜透析充分性研究）的患者被随机分为对照组[标准4×2L持续非卧床腹膜透析（CAPD）；n = 484]和干预组（目标肌酐清除率≥60L/周/1.73m²的CAPD；n = 481）。在基线时测量利钠肽，并将其与其他参数进行相关性分析，同时评估其对患者预后的影响。
结果
在所有测量参数方面，对照组和干预组在基线时具有可比性。利钠肽的基线值升高，且与残余肾功能水平显著相关，但与体型或糖尿病无关。B型利钠肽N末端片段（NT-proBNP）的基线值而非proANP({1 - 30})、proANP({31 - 67})或proANP(_{1 - 98})是总体生存和心血管死亡率的独立高度预测指标。超滤量也与患者生存率显著相关。
结论
NT-proBNP对CAPD患者的生存具有显著预测价值，可能在指导风险分层和潜在的靶向治疗干预方面具有重要意义。
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