|
Abstract
Background. N-terminal fragment of B-type natriuretic
peptide (NT-proBNP) is a marker of both fluid volume
overload and myocardial damage, and it has been useful
as a predictor of mortality in patients with end-stage renal
disease (ESRD). It has been suggested that continuous ambulatory
peritoneal dialysis (CAPD), automated peritoneal
dialysis (APD) and haemodialysis (HD) may have different
effects on fluid volume and blood pressure control; however,
whether the independent predictive value of NT-proBNP for
mortality is preserved when analysed in conjunction with
fluid overload and dialysis modality is not clear.
Methods. A prospective multicentre cohort of 753 prevalent
adult patients on CAPD, APD and HD was followed up
for 16 months. Plasmatic levels ofNT-proBNP, extracellular
fluid volume/total body water ratio (ECFv/TBW) and traditional
clinical and biochemical markers for cardiovascular
damage risk were measured, and their role as predictors of
all-cause and cardiovascular mortality was analysed.
Results. NT-proBNP level, ECFv/TBW and other cardiovascular
damage risk factors were not evenly distributed
among the different dialysis modalities. NT-proBNP levels
and ECFv/TBWwere correlated with several inflammation,
malnutrition and myocardial damage markers. Multivariate
analysis showed that NT-proBNP levels and ECFv/TBW
were predictors of both all-cause and cardiovascular mortality,
independently of dialysis modality and the presence
of other known clinical and biochemical risk factors.
Conclusions. NT-proBNP is a reliable predictor of death
risk independently of the effect of dialysis modality on fluid
volume control, and the presence of other clinical and biochemical
markers recognized as risk factors for all-cause
and cardiovascular mortality. NT-pro-BNP is a good predictor
of mortality independently of fluid volume overload
and dialysis modality.
Keywords: end-stage renal disease; dialysis modality; NT-proBNP;
fluid overload; mortality
| 
