Koch M, Trapp R, Kohnle M, Aker S, Haastert B, Rump L-C
Center of Nephrology, Mettmann, Heinrich Heine University Düsseldorf, Germany. dialyse-mettmann.de
Clin Nephrol. 2010 Jan;73(1):21-9. doi: 10.5414/cnp73021.
The B-type natriuretic peptide (BNP) has become increasingly important as a diagnostic and prognostic method for cardiovascular disease or death. To our knowledge no prospective studies exist to evaluate the value of baseline BNP and baseline heart failure as predictors of overall death in incident rather than prevalent hemodialysis patients with end-stage renal disease (ESRD).
255 ESRD patients were included in our observational study with a median observation period of 1.11 years. A Kaplan-Meier survival curve was stratified by BNP concentration (< 340 pg/ml and > or = 340 pg/ml) to estimate the impact on the overall mortality rate. Univariate and multiple Cox regression models were fitted for a variety of covariables including severe heart failure (graded according to the New York Heart Association) to evaluate the independent predictors of death. Association between BNP and four explanatory variables was described in a multiple linear regression model.
Survival analysis demonstrated a significantly higher mortality rate in patients with higher BNP values at baseline. The independent predictive value of high BNP concentration at baseline could be statistically confirmed by multiple Cox regression analysis. However, when including the covariates hemoglobin and severe heart failure, significantly associated with BNP, in the same model, severe heart failure rather than BNP becomes a significant predictor of overall death.
A higher BNP level at baseline may be confirmed as an independent predictor of death in the incident dialysis population. However, severe heart failure may affect the impact of BNP on the overall survival rate and thus be a stronger predictor of death than BNP.
B型利钠肽（BNP）作为心血管疾病或死亡的诊断和预后方法，其重要性日益凸显。据我们所知，尚无前瞻性研究评估基线BNP和基线心力衰竭作为新发而非已患终末期肾病（ESRD）血液透析患者全因死亡预测指标的价值。
255例ESRD患者纳入我们的观察性研究，中位观察期为1.11年。根据BNP浓度（<340 pg/ml和≥340 pg/ml）绘制Kaplan-Meier生存曲线，以评估其对总死亡率的影响。对包括重度心力衰竭（根据纽约心脏协会分级）在内的多种协变量拟合单因素和多因素Cox回归模型，以评估死亡的独立预测因素。在多线性回归模型中描述BNP与四个解释变量之间的关联。
生存分析显示，基线BNP值较高的患者死亡率显著更高。多因素Cox回归分析可从统计学上证实基线高BNP浓度的独立预测价值。然而，当在同一模型中纳入与BNP显著相关的协变量血红蛋白和重度心力衰竭时，重度心力衰竭而非BNP成为全因死亡的显著预测因素。
基线BNP水平较高可被确认为新发透析人群死亡的独立预测因素。然而，重度心力衰竭可能会影响BNP对总生存率的影响，因此是比BNP更强的死亡预测因素。
