Pre-Dialysis Trajectory of BNP and Body Weight in Chronic Kidney Disease Patients: A Predictive Marker for Unplanned Dialysis Initiation

Figures

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  Figure 1. Flow diagram of patient selection. Among 449 patients initiating maintenance dialysis between April 2014 and March 2024, 218 were excluded because of previous kidney transplantation (n = 20), incomplete brain natriuretic peptide (BNP) data (n = 198), or use of angiotensin receptor-neprilysin inhibitors (ARNI) (n = 0). Thus, 231 patients were included in the final analysis.

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  Figure 2. Longitudinal changes in clinical parameters during the 12 months preceding dialysis initiation, stratified by initiation pattern. Trajectories for (A) brain natriuretic peptide (BNP), (B) body weight (BW), (C) urea nitrogen (UN), (D) estimated glomerular filtration rate (eGFR), (E) serum potassium level, and (F) hemoglobin (Hb) level are shown for patients with planned (•) and unplanned (▪) dialysis initiation. Values are presented as median with interquartile range.

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  Figure 3. Association between biomarker ratios and unplanned dialysis initiation assessed by adjusted restricted cubic spline analysis. (A) Brain natriuretic peptide (BNP) ratio. (B) Body weight (BW) ratio. Solid lines represent the adjusted odds ratio (OR), and dotted lines represent the 95% confidence intervals (CI). The reference point (OR = 1) is set at the median value of each respective ratio. Models were adjusted for age, sex, Charlson comorbidity index, potassium level, estimated glomerular filtration rate, and use of renin–angiotensin system inhibitors.