Nongnuch Arkom, Panorchan Kwanpeemai, Davenport Andrew
Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Am J Nephrol. 2014;40(3):251-7. doi: 10.1159/000368376. Epub 2014 Oct 14.
Increased natriuretic peptides are associated with increased cardiovascular and all-cause mortality for haemodialysis (HD) patients. However, debate continues whether these biomarkers are increased by extracellular water (ECW) excess and can be used to aid clinical assessment of volume status and help determine target weight.
We measured N terminal probrain natriuretic peptide (NT-proBNP) predialysis in 375 stable haemodialysis outpatients with corresponding pre and postdialysis multifrequency bioelectrical impedance assessments (MFBIA) of (ECW)/total body water (TBW).
Median age 64 (51-75), 63.9% male, 42.9% diabetic, 43.2% Caucasoid, 14.4% with a history of myocardial infarction, 8.4% coronary artery bypass surgery, dialysis vintage 28.2 (12.3-55.5) months. Median predialysis NT-proBNP 283 (123-989) pmol/l, and predialysis ECW/TBW ratio 0.397 ± 0.029. On multivariate analysis, predialysis log NT-proBNP was associated with predialysis systolic blood pressure (β 0.007, p = 0.000), weight (β -0.008, p = 0.001), valvular heart disease (β 0.342, p = 0.015, ECW/TBW (β 1.3, p = 0.019) and log CRP (β 0.145, p = 0.037). Dividing patients into NTproBNP quartiles, %ECW/TBW and relative ECW overhydration were significantly greater for the highest quartile vs. lowest (40.5 ± 4.1 vs. 39.0 ± 1.1, and 1.51 ± 1.24 vs. 0.61 ± 0.69 l, respectively, p < 0.001).
In this study, predialysis NTproBNP values were associated with direct assessments of the extracellular volume excess measured by MFBIA and systolic arterial blood pressure. This suggests that predialysis NTproBNP values can potentially be used to aid clinical assessment of volume status in dialysis patients to determine target weight.
利钠肽水平升高与血液透析（HD）患者心血管疾病及全因死亡率增加相关。然而，关于这些生物标志物是否因细胞外液（ECW）过多而升高，以及能否用于辅助评估容量状态和确定目标体重，仍存在争议。
我们对375例稳定的血液透析门诊患者进行了透析前N末端脑钠肽前体（NT-proBNP）测量，并采用多频生物电阻抗分析（MFBIA）对透析前后的ECW/总体水（TBW）进行了相应评估。
中位年龄64岁（51 - 75岁），男性占63.9%，糖尿病患者占42.9%，白种人占43.2%，有心肌梗死病史者占14.4%，接受冠状动脉搭桥手术者占8.4%，透析龄28.2个月（12.3 - 55.5个月）。透析前NT-proBNP中位数为283（123 - 989）pmol/l，透析前ECW/TBW比值为0.397±0.029。多因素分析显示，透析前log NT-proBNP与透析前收缩压（β 0.007，p = 0.000）、体重（β -0.008，p = 0.001）、心脏瓣膜病（β 0.342，p = 0.015）、ECW/TBW（β 1.3，p = 0.019）及log CRP（β 0.145，p = 0.037）相关。将患者分为NT-proBNP四分位数组，最高四分位数组的%ECW/TBW及相对ECW水过多情况显著高于最低四分位数组（分别为40.5±4.1 vs. 39.0±1.1，以及1.51±1.24 vs. 0.61±0.69 l，p < 0.001）。
在本研究中，透析前NT-proBNP值与通过MFBIA直接评估的细胞外液过多及收缩动脉血压相关。这表明透析前NT-proBNP值有可能用于辅助评估透析患者的容量状态以确定目标体重。
