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Brain natriuretic peptide and all-cause mortality in patients treated with haemodialysis
Maria K Svensson1,2, Rita Nassar1, Jan Melin1
1Department of Medical Sciences, Renal Medicine, Uppsala University Hospital, Akademiska sjukhuset, Entrance 40, floor 5, Uppsala, SE, 751 85, Sweden.
Insights
Brain natriuretic peptide (BNP) correlated with mortality in chronic kidney disease (CKD) patients on hemodialysis. However, age, inflammation, and handgrip strength were more significant predictors of mortality than BNP.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Brain natriuretic peptide (BNP) is a hormone released by the heart in response to fluid overload.
- In chronic kidney disease (CKD) patients undergoing hemodialysis, fluid overload and overhydration (OH) are significant mortality risks.
- This study explores the relationship between BNP, OH, and mortality in CKD patients on hemodialysis.
Purpose of the Study:
- To investigate the association between BNP levels and all-cause mortality in CKD patients on hemodialysis.
- To determine if overhydration (OH) is a significant factor in mortality for this patient group.
- To identify key clinical and biochemical predictors of mortality in CKD patients undergoing hemodialysis.
Main Methods:
- Prospective observational study analyzing five-year survival in 64 CKD patients on hemodialysis.
- Bivariate correlation analysis to assess relationships between BNP, OH, and all-cause mortality.
- Cox regression analysis to adjust for clinical and biochemical factors influencing the BNP-mortality relationship.
Main Results:
- 52% of patients died during the five-year study period.
- BNP, age, handgrip strength, lean tissue index, and CRP levels were initially associated with all-cause mortality.
- After adjusting for covariates, age, handgrip strength, and CRP emerged as independent predictors of mortality, while BNP did not.
Conclusions:
- BNP showed a correlation with all-cause mortality in CKD patients on hemodialysis, but OH did not.
- Age, inflammation (CRP), and handgrip strength were identified as more significant independent predictors of mortality than BNP.
- These findings suggest focusing on these clinical factors for risk stratification in CKD patients undergoing hemodialysis.
Background:
Brain natriuretic peptide (BNP) is a hormone secreted from the heart in response to fluid overload. In patients with chronic kidney disease (CKD), inadequate fluid management during haemodialysis may cause fluid overload and overhydration (OH), risk factors for mortality. The aim of this exploratory pilot study was to analyse the relationships between BNP, OH and all-cause mortality in patients with CKD and haemodialysis.
Methods:
In this prospective observational study, five-year survival was analysed in 64 patients with CKD and haemodialysis. Bivariate correlations were performed to analyse the relationships between BNP, OH, and all-cause mortality. Cox regression analysis was performed to adjust the relationship between BNP and all-cause mortality for selected clinical and biochemical characteristics, collected at baseline.
Results:
By the end of the study, 33 patients (52%) had died. In bivariate correlation analysis age (r = 0.38), BNP (r = 0.48), handgrip strength (r=-0.34), lean tissue index (r=-0.41) and CRP level (r=-0.34, p = 0.007) were significantly associated with all-cause mortality. In a linear regression model, BNP was found to be a significant predictor of all-cause mortality (HR 2.61). However, after adjusting for age, handgrip strength, and CRP, BNP was no longer a statistically significant predictor of all-cause mortality. Instead, age, handgrip strength and CRP were significant predictors of all-cause mortality (HR 1.04; HR 0.95 and HR 2.61, respectively).
Conclusions:
In this study, BNP was correlated with all-cause mortality in patients with CKD and haemodialysis, but OH was not. When adjusting for other clinical and biochemical factors, age, inflammation, and handgrip strength were found to be independent and more important predictors of all-cause mortality than BNP.
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