Gutiérrez Orlando M, Tamez Hector, Bhan Ishir, Zazra James, Tonelli Marcello, Wolf Myles, Januzzi James L, Chang Yuchiao, Thadhani Ravi
Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Clin Chem. 2008 Aug;54(8):1339-48. doi: 10.1373/clinchem.2007.101691. Epub 2008 Jun 6.
Increased N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations are associated with increased cardiovascular mortality in chronic hemodialysis patients. Previous studies focused on prevalent dialysis patients and examined single measurements of NT-proBNP in time.
We measured NT-proBNP concentrations in 2990 incident hemodialysis patients to examine the risk of 90-day and 1-year mortality associated with baseline NT-proBNP concentrations. In addition, we calculated the change in concentrations after 3 months in a subset of 585 patients to examine the association between longitudinal changes in NT-proBNP and subsequent mortality.
Increasing quartiles of NT-proBNP were associated with a monotonic increase in 90-day [quartile 1, referent; from quartile 2 to quartile 4, hazard ratio (HR) 1.7-6.3, P < 0.001] and 1-year (quartile 1, referent; from quartile 2 to quartile 4, HR 1.7-4.9, P < 0.001) all-cause mortality. After multivariable adjustment, these associations remained robust. When examined using a multivariable fractional polynomial, increased NT-proBNP concentrations were associated with increased 90-day (HR per unit increase in log NT-proBNP 1.5, 95% CI 1.3-1.7) and 1-year (HR per unit increase in log NT-proBNP 1.4, 95% CI 1.3-1.5) all-cause mortality. In addition, patients with the greatest increase in NT-proBNP after 3 months of dialysis had a 2.4-fold higher risk of mortality than those with the greatest decrease in NT-proBNP.
NT-proBNP concentrations are independently associated with mortality in incident hemodialysis patients. Furthermore, the observation that longitudinal changes in NT-proBNP concentrations were associated with subsequent mortality suggests that monitoring serial NT-proBNP concentrations may represent a novel tool for assessing adequacy and guiding therapy in patients initiating hemodialysis.
慢性血液透析患者中，N端前体B型钠尿肽（NT-proBNP）浓度升高与心血管死亡率增加相关。既往研究聚焦于现患透析患者，并及时检测NT-proBNP的单次测量值。
我们测量了2990例新发血液透析患者的NT-proBNP浓度，以研究基线NT-proBNP浓度与90天和1年死亡率的风险。此外，我们计算了585例患者亚组在3个月后的浓度变化，以研究NT-proBNP的纵向变化与后续死亡率之间的关联。
NT-proBNP四分位数增加与90天（四分位数1，参照组；四分位数2至四分位数4，风险比[HR] 1.7 - 6.3，P < 0.001）和1年（四分位数1，参照组；四分位数2至四分位数4，HR 1.7 - 4.9，P < 0.001）全因死亡率的单调增加相关。多变量调整后，这些关联依然显著。使用多变量分数多项式进行检验时，NT-proBNP浓度升高与90天（log NT-proBNP每单位增加的HR为1.5，95%可信区间[CI] 1.3 - 1.7）和1年（log NT-proBNP每单位增加的HR为1.4，95% CI 1.3 - 1.5）全因死亡率增加相关。此外，透析3个月后NT-proBNP升高幅度最大的患者，其死亡风险比NT-proBNP降低幅度最大的患者高2.4倍。
NT-proBNP浓度与新发血液透析患者的死亡率独立相关。此外，NT-proBNP浓度的纵向变化与后续死亡率相关这一观察结果表明，监测NT-proBNP系列浓度可能是评估初始血液透析患者充分性和指导治疗的一种新工具。
