Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Eur J Heart Fail. 2011 Aug;13(8):860-7. doi: 10.1093/eurjhf/hfr057. Epub 2011 May 30.
Cardiac disease is the major cause of death in patients undergoing chronic haemodialysis. Recent studies have found that B-type natriuretic peptide (BNP) levels accurately reflect the cardiovascular burden of dialysis patients. However, the prognostic potential of BNP measurements in dialysis patients remains unknown.
The study included 113 chronic dialysis patients who were prospectively followed up. Levels of BNP were measured at baseline and every 6 months thereafter. The potential of baseline BNP and annual BNP changes to predict all-cause and cardiac mortality were assessed as endpoints. Median follow-up was 735 (354-1459) days; 35 (31%) patients died, 17 (15%) of them from cardiac causes. Baseline BNP levels were similar among survivors and non-survivors, and failed to predict all-cause and cardiac death. Cardiac death was preceded by a marked increase in BNP levels. In survivors BNP levels remained stable [median change: +175% (+20-+384%) vs. -14% (-35-+35%) over the 18 months preceding either death or the end of follow-up, P< 0.001]. Hence, annual BNP changes adequately predicted all-cause and cardiac death in the subsequent year {AUC(all-cause) = 0.70 [SD 0.05, 95% CI (0.60-0.81)]; AUC(cardiac) = 0.82 [SD 0.04, 95%CI (0.73-0.90)]}. A BNP increase of 40% provided the best cut-off level. Cox regression analysis confirmed that annual increases over 40% were associated with a seven-fold increased risk for all-cause and cardiac death.
Annual BNP increases above 40% predicted all-cause and cardiac death in the subsequent year. Hence, serially measuring BNP levels may present a novel tool for risk stratification and treatment guidance of end-stage renal disease patients on chronic dialysis.
心脏病是慢性血液透析患者的主要死亡原因。最近的研究发现，B 型利钠肽（BNP）水平能准确反映透析患者的心血管负担。然而，BNP 测量在透析患者中的预后潜力尚不清楚。
本研究纳入了 113 名接受前瞻性随访的慢性透析患者。在基线和此后每 6 个月测量 BNP 水平。评估基线 BNP 和年度 BNP 变化预测全因和心脏死亡率的潜力作为终点。中位随访时间为 735（354-1459）天；35 名（31%）患者死亡，其中 17 名（15%）死于心脏原因。幸存者和非幸存者的基线 BNP 水平相似，无法预测全因和心脏死亡。心脏死亡前 BNP 水平明显升高。在幸存者中，BNP 水平保持稳定[中位数变化：+175%（+20-+384%）比死亡或随访结束前 18 个月的-14%（-35-+35%），P<0.001]。因此，年度 BNP 变化能充分预测下一年的全因和心脏死亡{AUC（全因）=0.70[SD0.05，95%CI（0.60-0.81）]；AUC（心脏）=0.82[SD0.04，95%CI（0.73-0.90）]}。BNP 增加 40%提供了最佳截断值。Cox 回归分析证实，每年增加超过 40%与全因和心脏死亡的风险增加 7 倍相关。
年度 BNP 增加超过 40%预测下一年的全因和心脏死亡。因此，连续测量 BNP 水平可能为慢性透析的终末期肾病患者提供一种新的风险分层和治疗指导工具。
