Svensson M, Gorst-Rasmussen A, Schmidt E B, Jorgensen K A, Christensen J H
Department of Nephrology, Aalborg Hospital, Aarhus University Hospital, Aarhus, Denmark.
Clin Nephrol. 2009 Apr;71(4):380-6. doi: 10.5414/cnp71380.
Patients with end-stage renal disease (ESRD) have an increased mortality from cardiovascular disease (CVD). N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is an independent predictor of mortality in patients with ischemic heart disease and congestive heart failure. Previous data have shown markedly elevated levels of NT-pro-BNP in patients with ESRD, while the prognostic value of elevated levels of NT-pro-BNP in patients with ESRD is largely unknown. The aim of the present study was to examine if the level of NT-pro-BNP predicts mortality in patients with ERSD and CVD.
We prospectively followed 206 patients with ESRD and documented CVD. Levels of NT-pro-BNP were measured at baseline, and patients were followed for 2 years or until they reached the predefined endpoint of all-cause mortality.
During follow-up, the total mortality was 44% (90/206). Patients who died were followed for a median of 314 days (interquartile range 179 - 530). Using Cox regression analysis, age, female sex, systolic blood pressure, dialysis efficiency and plasma levels of NT-pro-BNP were independent prognostic risk factors of mortality. In receiver operating characteristic curve analysis a cut off value for NT-pro-BNP was determined. Patients with values of NT-pro-BNP above 12.200 pg/ml had a 3 times higher risk of death than patients below the cut-off value (HR 3.05 95% CI 1.96 - 4.77, p < 0.0001).
In spite of generally elevated levels of NT-pro-BNP, NT-pro-BNP is still an independent predictor of mortality and might add prognostic information in patients with ESRD and documented CVD.
终末期肾病（ESRD）患者心血管疾病（CVD）导致的死亡率升高。N端前脑钠肽（NT-pro-BNP）是缺血性心脏病和充血性心力衰竭患者死亡率的独立预测因子。既往数据显示ESRD患者的NT-pro-BNP水平显著升高，而ESRD患者NT-pro-BNP水平升高的预后价值在很大程度上尚不清楚。本研究的目的是检验NT-pro-BNP水平是否可预测ESRD合并CVD患者的死亡率。
我们对206例ESRD合并CVD患者进行了前瞻性随访。在基线时测量NT-pro-BNP水平，并对患者随访2年或直至达到全因死亡率的预定义终点。
随访期间，总死亡率为44%（90/206）。死亡患者的中位随访时间为314天（四分位间距179 - 530）。使用Cox回归分析，年龄、女性、收缩压、透析效率和NT-pro-BNP血浆水平是死亡率的独立预后危险因素。在受试者工作特征曲线分析中确定了NT-pro-BNP的临界值。NT-pro-BNP值高于12200 pg/ml的患者死亡风险比低于临界值的患者高3倍（风险比3.05，95%置信区间1.96 - 4.77，p < 0.0001）。
尽管NT-pro-BNP水平普遍升高，但NT-pro-BNP仍是死亡率的独立预测因子，可能为ESRD合并CVD患者增加预后信息。
