Soluble neprilysin, NT-proBNP, and growth differentiation factor-15 as biomarkers for heart failure in dialysis patients (SONGBIRD)

Figures

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  Fig. 1. Biomarkers in patients with HF and controls. a The graph shows Tukey boxplots, p for T test of normalized log-transformed values. b NT-proBNP is freely permeable across the peritoneal membrane, while cNEP is not, as demonstrated by correlation analysis of dialysate with serum or plasma concentrations of NT-proBNP and cNEP; r for Pearson’s correlation. Act. Activity, conc. Concentration, MW molecular weight

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  Fig. 2. Distribution of volume overload (a + c) and systolic dysfunction (LVEF < 50%) (b + d) according to the circulating concentrations of NT-proBNP and either cNEP activity (a + b) or GDF-15 (c + d). Values of NT-proBNP, cNEP activity, and GDF were naturally log-transformed and sex-standardized. Groups were divided into quadrants according to the medians of resulting Z scores (represented by lines). Percentages refer to the prevalence of volume overload (a + c) and LVEF < 50% (b + d) per quadrant

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  Fig. 3. Comparison of areas under the receiver operating characteristics (ROC) curves for prediction of congestive heart failure. Models 0–3 denote the clinical base model supplemented with respective biomarker information, p < 0.001 for ROC curves of all models against line of no information. Model 3 demonstrated the largest AUC with 0.902 (95% CI 0.857–0.947) and provided incremental predictive utility over model 0 (p < 0.001), model 1 (p < 0.001), and model 2 (p < 0.001), respectively. Biomarker cutoff values in the insert represent the best relation between sensitivity and specificity (circle). The clinical base model included the following covariates: age, dyspnea score, systolic blood pressure, Charlson comorbidity index, history of congestive heart failure, history of severe valve disease, and extracellular to total body water ratio