Key result
Elevated NTproBNP levels (>7,350 pg/mL) were associated with a 3-fold higher risk of outpatient sudden cardiac death compared to the lowest tertile (HR 3.03) in hemodialysis patients.
Why the study?
Does elevated serum NTproBNP and cTnI predict outpatient sudden cardiac death in hemodialysis patients?
Cohort (n=503)
Yes
Does elevated serum NTproBNP and cTnI predict outpatient sudden cardiac death in hemodialysis patients?
Hazard Ratio: 3.03 (95% CI 1.56–5.89)
Absolute Event Rate: 78.9% vs 19%
p-value: p=0.001
Elevated NTproBNP is strongly associated with an increased risk of outpatient sudden cardiac death in hemodialysis patients and improves risk prediction beyond conventional factors.
May aid SCD risk stratification in hemodialysis; leaves open need for prospective validation before guiding interventions.
BACKGROUND: Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP) troponin I (cTnI) in hemodialysis patients. METHODS: We measured NTproBNP and cTnI in 503 hemodialysis patients of a national prospective cohort study. We determined their association with SCD using Cox regression, adjusting for demographics, co-morbidities, and clinical factors and risk prediction using C-statistic and Net Reclassification Improvement (NRI). RESULTS: Patients' mean age was 58 years and 54 % were male. During follow-up (median 3.5 years), there were 75 outpatient SCD events. In unadjusted and fully-adjusted models, NTproBNP had a significant association with the risk of SCD. Analyzed as a continuous variable, the risk of SCD increased 27 % with each 2-fold increase in NTproBNP (HR, 1.27 per doubling; 95 % CI, 1.13-1.43; p < 0.001). In categorical models, the risk of SCD was 3-fold higher in the highest tertile of NTproBNP (>7,350 pg/mL) compared with the lowest tertile (<1,710 pg/mL; HR for the highest tertile, 3.03; 95 % CI, 1.56-5.89; p = 0.001). Higher cTnI showed a trend towards increased risk of SCD in fully adjusted models, but was not statistically significant (HR, 1.17 per doubling; 95 % CI, 0.98-1.40; p = 0.08). Sensitivity analyses using competing risk models showed similar results. Improvement in risk prediction by adding cardiac biomarkers to conventional risk factors was greater with NTproBNP (C-statistic for 3-year risk: 0.810; 95 % CI, 0.757 to 0.864; and continuous NRI: 0.270; 95 % CI, 0.046 to 0.495) than with cTnI. CONCLUSIONS: NTproBNP is associated with the risk of SCD in hemodialysis patients. Further research is needed to determine if biomarkers measurement can guide SCD risk prevention strategies in dialysis patients.
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Kruzan et al. (2016) conducted a cohort in Hemodialysis (n=503). Elevated NTproBNP (>7,350 pg/mL) vs. Low NTproBNP (<1,710 pg/mL) was evaluated on Outpatient sudden cardiac death (HR 3.03, 95% CI 1.56-5.89, p=0.001). Elevated NTproBNP levels (>7,350 pg/mL) were associated with a 3-fold higher risk of outpatient sudden cardiac death compared to the lowest tertile (HR 3.03) in hemodialysis patients.
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