NDT Advance Access originally published online on August 31, 2008
Nephrology Dialysis Transplantation 2009 24(2):597-603; doi:10.1093/ndt/gfn491
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Plasma B-type natriuretic peptide levels reflect the presence and severity of stable coronary artery disease in chronic haemodialysis patients
1 Division of Hypertension and Nephrology, National Cardiovascular Center, Suita 2 Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 3 Division of Cardiology, Department of Internal Medicine, Kinki University School of Medicine, Osakasayama 4 Division of Cardiology, National Cardiovascular Center, Suita, Japan
Correspondence and offprint requests to: Yoshitaka Iwanaga, Division of Cardiology, Department of Internal Medicine, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osakasayama 589-8511, Japan. Tel: +81-72-366-0221; Fax: +81-72-368-2378; E-mail: yiwanaga{at}med.kindai.ac.jp
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Abstract |
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Background. Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality in haemodialysis (HD) patients. Although the plasma B-type natriuretic peptide (BNP) levels may be a strong marker of long-term mortality in HD patients, what plasma BNP levels reflect is not well known in this setting. Therefore, we examined the relationship between plasma BNP levels and the presence and severity of stable CAD based on coronary angiography (CAG) in chronic HD patients.
Methods. Plasma BNP levels were measured in 179 consecutive HD patients who were referred for CAG due to symptoms or objective signs of stable CAD. Left ventricular end-diastolic wall stress (LV EDWS) was also calculated as a crucial haemodynamic determinant of plasma BNP.
Results. Plasma BNP levels were significantly higher in patients with CAD than in those with non-CAD. The area under the receiver operating characteristic curve for BNP to predict CAD was 0.837. Plasma BNP levels increased progressively with the extent of CAD [1-vessel disease (VD), 496 ± 49 pg/ml; 2-VD, 932 ± 119 pg/ml; 3-VD, 2073 ± 317 pg/ml; P < 0.01]. LV EDWS was well correlated with plasma BNP levels (r = 0.61, P < 0.01), and a multivariable regression analysis that took into account EDWS demonstrated a significant association between the extent of CAD and BNP (P < 0.01).
Conclusions. These results suggest that the presence and severity of stable CAD determine plasma BNP levels in chronic HD patients. Plasma BNP levels may be a useful marker in the management of HD patients.
Keywords: BNP; coronary artery disease; haemodialysis; left ventricular diastolic wall stress
Received for publication: 23. 5.08
Accepted in revised form: 7. 8.08