de Roij van Zuijdewijn Camiel L M, van Gastel Lieke H A, Ter Wee Piet M, Bots Michiel L, Blankestijn Peter J, van den Dorpel Marinus A, Fouque Denis, Nubé Menso J, Grooteman Muriel P C
Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Clin Kidney J. 2019 Nov 18;14(1):375-381. doi: 10.1093/ckj/sfz156. eCollection 2021 Jan.
C-type natriuretic peptide (CNP) and its co-product N-terminal proCNP (NTproCNP) have been associated with beneficial effects on the cardiovascular system. In prevalent dialysis patients, however, a relation between NTproCNP and mortality has not yet been investigated. Furthermore, as a middle molecular weight substance, its concentration might be influenced by dialysis modality.
In a cohort of patients treated with haemodialysis (HD) or haemodiafiltration (HDF), levels of NTproCNP were measured at baseline and 6, 12, 24 and 36 months. The relation between serum NTproCNP and mortality and the relation between the 6-month rate of change of NTproCNP and mortality were analysed using Cox regression models. For the longitudinal analyses, linear mixed models were used.
In total, 406 subjects were studied. The median baseline serum NTproCNP was 93 pmol/L and the median follow-up was 2.97 years. No relation between baseline NTproCNP or its rate of change over 6 months and mortality was found. NTproCNP levels remained stable in HD patients, whereas NTproCNP decreased significantly in HDF patients. The relative decline depended on the magnitude of the convection volume.
In our study, levels of NTproCNP appear strongly elevated in prevalent dialysis patients. Second, while NTproCNP remains unaltered in HD patients, its levels decline in individuals treated with HDF, with the decline dependent on the magnitude of the convection volume. Third, NTproCNP is not related to mortality in this population. Thus NTproCNP does not seem to be a useful marker for mortality risk in dialysis patients.
C型利钠肽（CNP）及其副产物N端前体CNP（NTproCNP）已被证明对心血管系统具有有益作用。然而，在接受透析的患者中，NTproCNP与死亡率之间的关系尚未得到研究。此外，作为一种中分子量物质，其浓度可能会受到透析方式的影响。
在一组接受血液透析（HD）或血液透析滤过（HDF）治疗的患者中，在基线以及6、12、24和36个月时测量NTproCNP水平。使用Cox回归模型分析血清NTproCNP与死亡率之间的关系以及NTproCNP 6个月变化率与死亡率之间的关系。对于纵向分析，使用线性混合模型。
总共研究了406名受试者。基线血清NTproCNP的中位数为93 pmol/L，中位随访时间为2.97年。未发现基线NTproCNP或其6个月内的变化率与死亡率之间存在关联。HD患者的NTproCNP水平保持稳定，而HDF患者的NTproCNP显著下降。相对下降程度取决于对流体积的大小。
在我们的研究中，接受透析的患者中NTproCNP水平似乎显著升高。其次，虽然HD患者的NTproCNP保持不变，但接受HDF治疗的患者其水平下降，且下降程度取决于对流体积的大小。第三，在该人群中NTproCNP与死亡率无关。因此，NTproCNP似乎不是透析患者死亡风险的有用标志物。
