Snaedal Sunna, Qureshi Abdul R, Carrero Juan J, Heimbürger Olof, Stenvinkel Peter, Bárány Peter
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Blood Purif. 2014;37(2):138-45. doi: 10.1159/000360267. Epub 2014 Apr 8.
BACKGROUND/AIMS: N-Terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor of cardiac events and death in the general population and in chronic kidney disease. There is limited information on how natriuretic peptides vary in dialysis patients. The aim of this study was to analyze NT-proBNP variability, factors predicting its variability and survival related to NT-proBNP variability.
A prospective 3-month observational study of prevalent hemodialysis patients with monthly measurements of NT-proBNP was carried out. A total of 211 hemodialysis patients were included, and mortality was recorded during 52 months of follow-up.
Inflammation was the strongest predictor of NT-proBNP variability. Patients with constantly high NT-proBNP had an increased risk of death adjusting for age, sex, dialysis vintage and comorbidity but not when also adjusting for nutritional status.
Longitudinal changes in NT-proBNP are associated with changes in inflammation, nutritional status, age and comorbidity. Due to strong interactions with predictors of mortality such as nutritional status, we were unable to confirm NT-proBNP as an independent marker for mortality in dialysis patients.
背景/目的：N末端脑钠肽前体（NT-proBNP）是普通人群和慢性肾脏病患者心脏事件及死亡的预测指标。关于利钠肽在透析患者中的变化情况，相关信息有限。本研究旨在分析NT-proBNP的变异性、预测其变异性的因素以及与NT-proBNP变异性相关的生存率。
对现患血液透析患者进行为期3个月的前瞻性观察研究，每月测量NT-proBNP。共纳入211例血液透析患者，并在52个月的随访期间记录死亡率。
炎症是NT-proBNP变异性的最强预测因素。NT-proBNP持续处于高水平的患者，在调整年龄、性别、透析龄和合并症后死亡风险增加，但在同时调整营养状况后则不然。
NT-proBNP的纵向变化与炎症、营养状况、年龄和合并症的变化相关。由于与营养状况等死亡率预测因素存在强烈相互作用，我们无法确认NT-proBNP为透析患者死亡率的独立标志物。
