Key result
Baseline NT-pro-BNP ≥ 9252 pg/mL was associated with a significantly increased risk of stroke (HR 4.1; 95% CI 2.0-8.4) and mortality (HR 2.1; 95% CI 1.6-2.7) compared to ≤ 1433 pg/mL.
Why the study?
Does elevated baseline or increasing NT-pro-BNP predict sudden death, stroke, myocardial infarction, and all-cause mortality in type 2 diabetes mellitus haemodialysis patients?
Cohort (n=1,255)
Does elevated baseline or increasing NT-pro-BNP predict sudden death, stroke, myocardial infarction, and all-cause mortality in type 2 diabetes mellitus haemodialysis patients?
Elevated baseline and increasing NT-pro-BNP levels are strong independent predictors of sudden death, stroke, cardiovascular events, and all-cause mortality in haemodialysis patients with type 2 diabetes.
Answers are grounded in this paper and cite their sources.
May support risk stratification in diabetic hemodialysis patients; leaves open whether serial NT-proBNP monitoring or interventions improve outcomes.
AIMS: N-terminal-pro-B-type-natriuretic-peptide (NT-pro-BNP) concentrations are altered in renal failure. This study examined the effect of baseline and change from baseline NT-pro-BNP on cardiovascular outcome and mortality in haemodialysis patients. METHODS AND RESULTS: On the basis of the German Diabetes and Dialysis Study, which evaluated atorvastatin in 1255 type 2 diabetes mellitus (T2DM) haemodialysis patients (median follow-up 4 years), the impact of NT-pro-BNP on pre-specified, adjudicated endpoints was investigated: sudden death (SD; n = 160), stroke (n = 99), myocardial infarction (MI; n = 200), cardiovascular events (CVEs: cardiac death, MI, stroke; n = 465), all-cause mortality (n = 612). Patients with baseline NT-pro-BNP ≥ 9252 pg/mL (fourth quartile) exhibited a more than four-fold risk of stroke [hazard ratio (HR) 4.1; 95% confidence interval (CI) 2.0-8.4] and a more than two-fold risk of SD (HR 2.0; 95% CI 1.2-3.3), CVE (HR 2.0; 95% CI 1.5-2.7), and mortality (HR 2.1; 95% CI 1.6-2.7) compared with patients with baseline NT-pro-BNP ≤ 1433 pg/mL (first quartile). Change in NT-pro-BNP was strongly associated with SD, CVE, and mortality. Doubling of NT-pro-BNP increased the risk of death by 46% (95% CI 1.1-2.0). Neither baseline nor change in NT-pro-BNP was significantly associated with MI. CONCLUSION: Increasing NT-pro-BNP is a risk factor for SD, CVE, and mortality in haemodialysis patients with T2DM. Whether NT-pro-BNP-guided treatment improves outcome needs to be evaluated prospectively.
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Winkler et al. (2008) conducted a cohort in Type 2 diabetes mellitus requiring haemodialysis (n=1,255). Baseline NT-pro-BNP ≥ 9252 pg/mL (fourth quartile) vs. Baseline NT-pro-BNP ≤ 1433 pg/mL (first quartile) was evaluated on Stroke (HR 4.1, 95% CI 2.0-8.4). Baseline NT-pro-BNP ≥ 9252 pg/mL was associated with a significantly increased risk of stroke (HR 4.1; 95% CI 2.0-8.4) and mortality (HR 2.1; 95% CI 1.6-2.7) compared to ≤ 1433 pg/mL.
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