NTproBNP levels in stable hemodialysis patients were not associated with cardiac dysfunction but were strongly dependent on factors associated with volume overload, particularly the predialysis ratio of extracellular water to total body water.
Observational (n=72)
No
Is NTproBNP associated with volume overload or cardiac dysfunction in stable hemodialysis patients?
In hemodialysis patients, NTproBNP levels are primarily driven by volume overload and potentially malnutrition rather than intrinsic cardiac dysfunction.
Effect estimate: Beta 26.6 (95% CI 16.8-36.4)
p-value: p=<0.001
BACKGROUND AND OBJECTIVES: N-terminal probrain type natriuretic peptide (NTproBNP) has been proven to be a valuable biomarker for predicting cardiac events and mortality in the hemodialysis population. However recent reports have suggested that NTproBNP is a marker of volume overload rather than one of cardiac dysfunction. Therefore this study investigated the effect of fluid volume status on NTproBNP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Volume status was determined pre- and postdialysis in 72 stable hemodialysis outpatients by multifrequency bioimpedance, and the relationship to NTproBNP values was examined. RESULTS: The mean and median NTproBNP values were 931.9 +/- 230 and 242 (90 to 688) pmol/L, respectively. On simple correlation, NTproBNP was associated with markers of volume overload and cardiac dysfunction. However, on logistical regression analysis, the strongest association was with the predialysis ratio of extracellular water/total body water (beta 26.6, F29.6, P = 0.000), followed by postdialysis mean arterial blood pressure (beta 0.14, F17.1, P = 0.000), dialysate calcium concentration (beta -1.19, F14.1, P = 0.002), and change in extracellular fluid volume with dialysis (beta 0.27, F7.4, P = 0.009) CONCLUSIONS: In this study, NTproBNP was not associated with cardiac dysfunction as assessed by transthoracic echo or nuclear medicine scintigraphy but was dependent on factors associated with volume overload. However, because bioimpedance results can also be affected by malnutrition with loss of cell mass, NTproBNP may be elevated not only in patients with volume overload, but also those with malnutrition.
Booth et al. (2010) conducted an observational in Hemodialysis (n=72). Fluid volume status assessment (multifrequency bioimpedance) was evaluated on Association of log NTproBNP with predialysis ratio of extracellular water to total body water (Beta 26.6, 95% CI 16.8-36.4, p=<0.001). NTproBNP levels in stable hemodialysis patients were not associated with cardiac dysfunction but were strongly dependent on factors associated with volume overload, particularly the predialysis ratio of extracellular water to total body water.