N-terminal pro brain natriuretic peptide predicts mortality in patients with end-stage renal disease in hemodialysis

Concentrations of N-terminal pro brain natriuretic peptide (NT-proBNP) increase in patients with heart failure and other cardiovascular ( CV) diseases and are strong prognostic markers. In patients with end-stage renal disease (ESRD) in hemodialysis (HD), levels of NT-proBNP are almost always raised. In ESRD patients undergoing HD, we aimed at (i) identifying the factors that affect levels of NT-proBNP, (ii) determining the effect of HD on NT-proBNP, and (iii) determining the prognostic impact of NT-proBNP. A total of 109 patients underwent physical examination, electrocardiogram, and echocardiography. Serum NT-proBNP was measured before and after HD (Elecsys 2010). NT-proBNP levels were markedly elevated (pre-HD 4079 pg/ml, post-HD 2759 pg/ml, P < 0.001). There was a strong inverse correlation between NT-proBNP and left ventricular ejection fraction (LVEF) (P = 0.043), 24-h urine production (P = 0.006), and K-t/V (efficacy of dialysis) (P = 0.016) and a positive correlation with left ventricular hypertrophy (LVH) (P = 0.014). Patients with higher concentrations, both pre- and post-HD had an increased mortality rate compared to those with lower concentrations (P = 0.007, P = 0.002). We found age (P = 0.009) and NT-proBNP (pre-HD P = 0.007, post- HD P = 0.001) predictive of death. Our findings demonstrate that CV disease in terms of LVH and reduced LVEF in addition to 24-h urine production and Kt/V determine NT-proBNP levels. Post-HD levels of NT-proBNP were lower than pre- HD levels; both predictive of mortality.