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This Article Full Text Full Text (PDF) Supplemental Data All Versions of this Article: clinchem.2007.101691v1 54/8/1339    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gutiérrez, O. M. Articles by Thadhani, R. Search for Related Content PubMed PubMed Citation Articles by Gutiérrez, O. M. Articles by Thadhani, R. Related Collections Proteomics and Protein Markers

N-terminal Pro-B–Type Natriuretic Peptide (NT-proBNP) Concentrations in Hemodialysis Patients: Prognostic Value of Baseline and Follow-up Measurements

¹ Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; ² Spectra Laboratories, Rockleigh, NJ; ³ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; ⁴ Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; ⁵ General Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

^aAddress correspondence to this author at: University of Miami, Rosenstiel Medical Science Building, Suite 7168, 1600 NW 10th Avenue, Miami, FL 33136. Fax 305-243-3506; e-mail ogutierrez2{at}med.miami.edu.

Background: Increased N-terminal pro-B–type natriuretic peptide (NT-proBNP) concentrations are associated with increased cardiovascular mortality in chronic hemodialysis patients. Previous studies focused on prevalent dialysis patients and examined single measurements of NT-proBNP in time.

Methods: We measured NT-proBNP concentrations in 2990 incident hemodialysis patients to examine the risk of 90-day and 1-year mortality associated with baseline NT-proBNP concentrations. In addition, we calculated the change in concentrations after 3 months in a subset of 585 patients to examine the association between longitudinal changes in NT-proBNP and subsequent mortality.

Results: Increasing quartiles of NT-proBNP were associated with a monotonic increase in 90-day [quartile 1, referent; from quartile 2 to quartile 4, hazard ratio (HR) 1.7–6.3, P < 0.001] and 1-year (quartile 1, referent; from quartile 2 to quartile 4, HR 1.7–4.9, P < 0.001) all-cause mortality. After multivariable adjustment, these associations remained robust. When examined using a multivariable fractional polynomial, increased NT-proBNP concentrations were associated with increased 90-day (HR per unit increase in log NT-proBNP 1.5, 95% CI 1.3–1.7) and 1-year (HR per unit increase in log NT-proBNP 1.4, 95% CI 1.3–1.5) all-cause mortality. In addition, patients with the greatest increase in NT-proBNP after 3 months of dialysis had a 2.4-fold higher risk of mortality than those with the greatest decrease in NT-proBNP.

Conclusions: NT-proBNP concentrations are independently associated with mortality in incident hemodialysis patients. Furthermore, the observation that longitudinal changes in NT-proBNP concentrations were associated with subsequent mortality suggests that monitoring serial NT-proBNP concentrations may represent a novel tool for assessing adequacy and guiding therapy in patients initiating hemodialysis.