University Clinic of Nephrology, Skopje, Republic of Macedonia.
Nephron Clin Pract. 2011;119(2):c162-70. doi: 10.1159/000327615. Epub 2011 Jul 8.
The ability of brain natriuretic peptide (BNP) together with other traditional and nontraditional risk factors to predict cardiovascular (CV) mortality in hemodialysis (HD) patients has not been well established. The aim of this prospective study was to determine the predictive cutoff values of baseline measurement of BNP along with the known CV disease risk factors to predict all-cause and CV mortality in HD patients.
BNP concentration before HD was measured in 125 prevalent HD patients (age 53.0 ± 13.5 years, HD vintage 75.2 ± 61.0 months). In addition, several traditional CV risk factors (blood pressure, dyslipidemia, diabetes mellitus, body mass index, left ventricular hypertrophy) and uremia/dialysis-related CV risk factors (anemia, calcium and phosphate impairment, malnutrition, inflammation, ultrafiltration, HD duration, Kt/V) were examined.
During the 2-year follow-up, we lost 28 out of 125 patients (22.5%), with CV disease (65.7%) being the main cause of mortality. The cutoff point for BNP, as predictor of the clinical outcome, according to the ROC curve was 1,194 pg/ml for CV mortality with sensitivity and specificity of 63 and 65%, respectively (AUC 0.61 and confidence interval (CI) 95% 0.47-0.75). Kaplan-Meier analysis showed that all-cause (log-rank, p = 0.002) and CV mortality (log-rank, p = 0.001) were the cause of a significantly lower survival in patients with a mean BNP >1,200 pg/ml. The univariate Cox regression analysis found the following factors to be predictors of all-cause mortality: hemoglobin (<110 g/l), phosphorus (>1.78 mmol/l), albumin (<40 g/l), C-reactive protein (CRP ≥ 10 mg/l), BNP (>1,200 pg/ml) and cardiac ejection fraction (≤ 55%). The multivariate Cox regression analyses demonstrated that only CRP ≥ 10 mg/l with a hazard ratio (HR) 6.82 (CI 95% 1.86-24.9, p = 0.004) and BNP >1,200 pg/ml with HR 5.79 (CI 95% 1.58-21.3, p = 0.004) were predictors of all-cause mortality. BNP >1,200 pg/ml with HR 13.52 (CI 95% 1.68-108.9, p = 0.014) was found to be an even stronger predictor of CV mortality than CRP ≥ 10 mg/l with HR 6.53 (CI 95% 1.35-31.6, p = 0.020).
Our study pointed out that BNP >1,200 pg/ml as a marker of cardiac dysfunction and CRP ≥ 10 mg/l as a marker of inflammation identify HD patients at increased risk of CV mortality.
脑钠肽（BNP）与其他传统和非传统危险因素联合预测血液透析（HD）患者心血管（CV）死亡率的能力尚未得到充分证实。本前瞻性研究旨在确定基线 BNP 测量值与已知 CV 疾病风险因素的预测截止值，以预测 HD 患者的全因和 CV 死亡率。
在 125 例现患 HD 患者（年龄 53.0±13.5 岁，HD 龄 75.2±61.0 个月）中测量 HD 前的 BNP 浓度。此外，还检查了几种传统 CV 危险因素（血压、血脂异常、糖尿病、体重指数、左心室肥厚）和尿毒症/透析相关 CV 危险因素（贫血、钙和磷损伤、营养不良、炎症、超滤、HD 持续时间、Kt/V）。
在 2 年的随访中，我们失去了 125 例患者中的 28 例（22.5%），CV 疾病（65.7%）是主要的死亡原因。根据 ROC 曲线，BNP 作为临床结局预测因子的截断点为 1194pg/ml，用于 CV 死亡率，灵敏度和特异性分别为 63%和 65%（AUC 0.61 和 95%CI 0.47-0.75）。Kaplan-Meier 分析显示，全因（对数秩，p=0.002）和 CV 死亡率（对数秩，p=0.001）是导致 BNP 平均值>1200pg/ml 的患者生存率显著降低的原因。单变量 Cox 回归分析发现以下因素是全因死亡率的预测因素：血红蛋白（<110g/l）、磷（>1.78mmol/l）、白蛋白（<40g/l）、C 反应蛋白（CRP≥10mg/l）、BNP（>1200pg/ml）和心脏射血分数（≤55%）。多变量 Cox 回归分析表明，仅 CRP≥10mg/l 的风险比（HR）为 6.82（95%CI 1.86-24.9，p=0.004）和 BNP>1200pg/ml 的 HR 为 5.79（95%CI 1.58-21.3，p=0.004）是全因死亡率的预测因素。BNP>1200pg/ml 的 HR 为 13.52（95%CI 1.68-108.9，p=0.014），被发现是 CRP≥10mg/l 的 HR（6.53，95%CI 1.35-31.6，p=0.020）的更强预测因子。
我们的研究指出，BNP>1200pg/ml 作为心脏功能障碍的标志物和 CRP≥10mg/l 作为炎症的标志物，可识别 CV 死亡率风险增加的 HD 患者。
