Norepinephrine, left ventricular disorders and volume excess in ESRD.

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Endocrinology

Background:

• End-stage renal disease (ESRD) is characterized by sympathetic over-activity.
• Left ventricular (LV) disorders and volume overload are common in ESRD, contributing to cardiovascular (CV) risk.
• Sympathetic over-activity may mediate CV risk associated with LV dysfunction and volume overload in ESRD.

Purpose of the Study:

• To investigate the relationship between atrial natriuretic peptide (ANP), a biomarker for LV disorders and volume excess, and plasma nor-epinephrine (NE) concentrations in ESRD patients.
• To model the risk for incident CV events using ANP and NE in ESRD patients without heart failure.

Main Methods:

• Cross-sectional analysis of 227 ESRD patients without heart failure.
• Measured plasma ANP and NE concentrations.
• Prospective 3.5-year follow-up to assess incident CV events.
• Multivariate Cox regression analysis to model CV risk.

Main Results:

• Plasma NE was strongly and independently correlated with ANP (β = 0.31, P < 0.001).
• ANP independently predicted CV events (HR 1.25).
• NE introduction into the model rendered ANP non-significant, while NE remained a significant predictor (HR 1.29, P = 0.02).

Conclusions:

• In ESRD patients without heart failure, NE is strongly related to ANP.
• NE captures the predictive power of ANP for CV events.
• Sympathetic over-activity, indicated by NE, may mediate CV risk in ESRD patients with LV disorders and volume excess.