3-4期慢性肾脏病患者的N末端脑钠肽前体水平与长期随访中的死亡率：HAPPY研究亚组分析

NT-proBNP level in stage 3-4 chronic kidney disease and mortality in long-term follow-up: HAPPY study subgroup analysis.

作者信息

Şimşek Mustafa Aytek, Değertekin Muzaffer, Türer Cabbar Ayça, Hünük Burak, Aktürk Serkan, Erdoğmuş Siyar, Mutlu Bülent, Kozan Ömer

机构信息

Department of Cardiology, Yeditepe University Faculty of Medicine, İstanbul, Turkey.

Department of Nephrology, Ankara City Hospital, Ankara, Turkey.

出版信息

Turk Kardiyol Dern Ars. 2020 Jul;48(5):454-460. doi: 10.5543/tkda.2020.57746.

DOI:10.5543/tkda.2020.57746

PMID:32633264

Abstract

OBJECTIVE

This was an investigation of the relationship between the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and mortality in patients with stage 3-4 chronic kidney disease (CKD).

METHODS

This study was designed as a subgroup analysis of the Heart Failure Prevalence and Predictors in Turkey (HAPPY) study. The HAPPY study included 4650 randomly selected individuals from the 7 geographical regions of Turkey. A total of 191 subjects from the original cohort with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.1.73 m² were enrolled in this study and the relationship between NT-proBNP and mortality was investigated. Prognostic variables for total and cardiovascular mortality were also examined using Cox regression analysis.

RESULTS

The mean length of follow-up was 76.12±22.45 months. The mean NT-proBNP level was 423.54±955.88 pg/mL. During follow-up, 51 subjects (26.7%) died from any cause and 36 subjects (18.8%) died from a cardiovascular cause. The presence of hypertension (hazard ratio [HR]: 1.89; 95% confidence interval [CI]: 1.01-3.50; p=0.048), anemia (HR: 2.49; 95% CI: 1.20-5.15; p=0.014), male gender (HR: 2.64; 95% CI: 1.44-4.86; p=0.002) and log NT-proBNP (HR: 4.93; 95% CI: 2.83-8.58; p<0.001) were independent variables for total mortality. The presence of hypertension (HR: 2.47; 95% CI: 1.09-5.56; p=0.029), male gender (HR: 2.79; 95% CI: 1.38-5.62; p=0.004), eGFR (HR: 0.94; 95% CI: 0.91-0.98; p=0.005) and log NT-proBNP (HR: 6.31; 95% CI: 3.11-12.81; p<0.001) were independent predictors of cardiovascular mortality.

CONCLUSION

NT-proBNP was found to be an independent prognostic marker in patients with stage 3-4 CKD.

摘要

目的

本研究旨在探讨3-4期慢性肾脏病（CKD）患者N末端脑钠肽前体（NT-proBNP）水平与死亡率之间的关系。

方法

本研究设计为土耳其心力衰竭患病率及预测因素（HAPPY）研究的亚组分析。HAPPY研究从土耳其7个地理区域随机选取了4650名个体。本研究纳入了原队列中估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²的191名受试者，研究NT-proBNP与死亡率之间的关系。还使用Cox回归分析检查了全因死亡率和心血管死亡率的预后变量。

结果

平均随访时间为76.12±22.45个月。NT-proBNP平均水平为423.54±955.88 pg/mL。随访期间，51名受试者（26.7%）死于任何原因，36名受试者（18.8%）死于心血管原因。高血压（风险比[HR]：1.89；95%置信区间[CI]：1.01-3.50；p=0.048）、贫血（HR：2.49；95%CI：1.20-5.15；p=0.014）、男性（HR：2.64；95%CI：1.44-4.86；p=0.002）和NT-proBNP对数（HR：4.93；95%CI：2.83-8.58；p<0.001）是全因死亡率的独立变量。高血压（HR：2.47；95%CI：1.09-5.56；p=0.029）、男性（HR：2.79；95%CI：1.38-5.62；p=0.004）、eGFR（HR：0.94；95%CI：0.91-0.98；p=0.005）和NT-proBNP对数（HR：6.31；95%CI：3.11-12.81；p<0.001）是心血管死亡率的独立预测因素。