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NDT Advance Access published online on August 12, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp395
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


NT-proBNP, Fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients

Ramón Paniagua1, María-de-Jesús Ventura1, Marcela Ávila-Díaz1, Héctor Hinojosa-Heredia2, Antonio Méndez-Durán3, Alfonso Cueto-Manzano4, Alejandra Cisneros5, Alfonso Ramos6, Clara Madonia-Juseino6, Francisco Belio-Caro7, Fernando García-Contreras8, Pedro Trinidad-Ramos9, Rosario Vázquez10, Begoña Ilabaca11, Guadalupe Alcántara1 and Dante Amato12

1 Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI 2 Hospital General de Zona 47 3 Hospital General Regional 25, Mexico City 4 Hospital de Especialidades CMN Occidente, Guadalajara, Jal 5 Hospital General de Zona 27, Mexico City 6 Hospital General Regional 2, Hermosillo, Sonora 7 Hospital General Regional 1, Morelia, Michoacan 8 Hospital General de Zona 2A, Mexico City 9 Hospital de Especialidades CMN Siglo XXI, Mexico City 10 Hospital General de Zona 194, Naucalpan, Estado de México 11 Hospital General de Zona 1A, Mexico City, Instituto Mexicano del Seguro Social, México 12 Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Estado de México, México

Correspondence and offprint requests to: Ramón Paniagua; E-mail: jpaniaguas{at}cis.gob.mx, ramon.paniagua{at}imss.gob.mx



  Abstract

Background. N-terminal fragment of B-type natriuretic peptide (NT-proBNP) is a marker of both fluid volume overload and myocardial damage, and it has been useful as a predictor of mortality in patients with end-stage renal disease (ESRD). It has been suggested that continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and haemodialysis (HD) may have different effects on fluid volume and blood pressure control; however, whether the independent predictive value of NT-proBNP for mortality is preserved when analysed in conjunction with fluid overload and dialysis modality is not clear.

Methods. A prospective multicentre cohort of 753 prevalent adult patients on CAPD, APD and HD was followed up for 16 months. Plasmatic levels of NT-proBNP, extracellular fluid volume/total body water ratio (ECFv/TBW) and traditional clinical and biochemical markers for cardiovascular damage risk were measured, and their role as predictors of all-cause and cardiovascular mortality was analysed.

Results. NT-proBNP level, ECFv/TBW and other cardiovascular damage risk factors were not evenly distributed among the different dialysis modalities. NT-proBNP levels and ECFv/TBW were correlated with several inflammation, malnutrition and myocardial damage markers. Multivariate analysis showed that NT-proBNP levels and ECFv/TBW were predictors of both all-cause and cardiovascular mortality, independently of dialysis modality and the presence of other known clinical and biochemical risk factors.

Conclusions. NT-proBNP is a reliable predictor of death risk independently of the effect of dialysis modality on fluid volume control, and the presence of other clinical and biochemical markers recognized as risk factors for all-cause and cardiovascular mortality. NT-pro-BNP is a good predictor of mortality independently of fluid volume overload and dialysis modality.

Keywords: end-stage renal disease; dialysis modality; NT-proBNP; fluid overload; mortality

Received for publication: 8.12.08
Accepted in revised form: 13. 7.09


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