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NDT Advance Access published online on August 19, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp417
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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


Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study

Leo H. Jacobs1,*, Jos J. van de Kerkhof2,*, Alma M. Mingels1, Valéria Lima Passos3, Vincent W. Kleijnen1, Albert H. Mazairac2, Frank M. van der Sande2, Will K. Wodzig1, Constantijn J. Konings4, Karel M. Leunissen2, Marja P. van Dieijen-Visser1 and Jeroen P. Kooman2

1 Department of Clinical Chemistry 2 Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht 3 Department of Methodology and Statistics, Maastricht University, Maastricht 4 Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands

Correspondence and offprint requests to: Leo Jacobs; E-mail: leo.jacobs{at}mumc.nl



  Abstract

Background. Inflammation, overhydration and elevated cardiac biomarkers are related to outcome in haemodialysis (HD) patients. Here, we explored the relationship between the body composition (BC), inflammation and cardiac biomarker concentrations in HD patients longitudinally.

Methods. A total of 44 HD patients were followed for 6 months. BC was assessed by multifrequency bioimpedance (BIA). Serum concentrations of cardiac troponin T (cTnT), high-sensitive C-reactive protein (hsCRP), brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) were assessed at 2 monthly intervals. The longitudinal data analysis was conducted with a marginal model.

Results. During the follow-up, the parameters describing the BC were highly predictive of both BNP and NT-proBNP and independent of gender, time, hsCRP and cTnT concentrations. The intracellular water (ICW)/body weight (BW) ratio (reflecting malnutrition) exerted a negative effect, whereas the extracellular water (ECW)/BW ratio (reflecting overhydration) had a positive effect on BNP and NT-proBNP concentrations. HsCRP and cTnT concentrations were significantly associated with each other. Furthermore, NT-proBNP concentrations were predictive of cTnT and hsCRP concentrations.

Conclusions. In the present study, we find a significant relation between BIA-derived BC parameters and natriuretic peptide concentrations. This relationship was independent of the cardiac history of the patient and suggests that the natriuretic peptide levels are to some degree modifiable by changing a patient's fluid distribution. Moreover, cTnT, BNP, NT-proBNP and hsCRP were significantly related, showing a complex relation between overhydration, malnutrition, inflammation and cardiac biomarkers in dialysis patients.

Keywords: bioimpedance; haemodialysis; natriuretic peptides; overhydration; troponin

* Both authors contributed equally.

Received for publication: 11.12.08
Accepted in revised form: 23. 7.09


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