II Department of Cardiology and Internal Medicine, Collegium Medicum, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland,
Family Medicine Unit, Collegium Medicum, School of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
Cardiorenal Med. 2019;9(2):125-134. doi: 10.1159/000496238. Epub 2019 Feb 6.
The risk of cardiovascular (CV) complications is much greater in patients with chronic kidney disease (CKD). The aim of this study was to assess predictors of mortality, renal failure progression, and the need for dialysis in patients with CKD.
The study group consisted of 70 patients with stage 3-5 CKD, followed up on average for 33.4 ± 15.6 months. Laboratory tests and echocardiography were performed on all patients. Composite endpoints were defined as (1) all-cause mortality and (2) mortality or renal replacement therapy (RRT), defined as the initiation of dialysis therapy.
During the observation period, 13 patients died and 11 began dialysis therapy. NT-proBNP was found to be a significant predictor in receiver operating characteristic curve analysis for all study endpoints. The optimal cutoff value for NT-proBNP as a predictor of mortality was 569.8 pg/mL, with a sensitivity of 53.8% and a specificity of 89.1%. For mortality or RRT, the cutoff value for NT-proBNP was 384.9 pg/mL, with a sensitivity and specificity of 70.8 and 72.7%, respectively. In a multivariate regression analysis, NT-proBNP was an independent predictor of mortality with an OR = 7.5 (95% CI: 1.05-53.87; p = 0.044) and of mortality or RRT with an OR = 4.7 (95% CI: 1.01-22.66; p = 0.048).
NT-proBNP is an independent predictor of mortality in patients with CKD and can also be useful for CV risk stratification in this patient population.
患有慢性肾脏病（CKD）的患者发生心血管（CV）并发症的风险要高得多。本研究旨在评估 CKD 患者的死亡率、肾功能衰竭进展和透析需求的预测因素。
研究组包括 70 名处于 3-5 期 CKD 的患者，平均随访 33.4±15.6 个月。所有患者均进行实验室检查和超声心动图检查。复合终点定义为（1）全因死亡率和（2）死亡率或肾脏替代治疗（RRT），定义为开始透析治疗。
在观察期间，13 名患者死亡，11 名患者开始透析治疗。在所有研究终点的受试者工作特征曲线分析中，NT-proBNP 被发现是一个显著的预测因素。NT-proBNP 作为死亡率预测指标的最佳截断值为 569.8pg/ml，其敏感性为 53.8%，特异性为 89.1%。对于死亡率或 RRT，NT-proBNP 的截断值为 384.9pg/ml，其敏感性和特异性分别为 70.8%和 72.7%。在多变量回归分析中，NT-proBNP 是死亡率的独立预测因素，OR=7.5（95%CI：1.05-53.87；p=0.044），也是死亡率或 RRT 的独立预测因素，OR=4.7（95%CI：1.01-22.66；p=0.048）。
NT-proBNP 是 CKD 患者死亡率的独立预测因素，也可用于该患者人群的 CV 风险分层。
