Abstract 4064: Plasma Brain Natriuretic Peptide Levels Are Related to Clinical Outcomes in Patients With End-Stage Renal Failure on Chronic Hemodialysis
Background: Recently, it has been reported that plasma brain natriuretic peptide (BNP) levels predict future cardiac events. The aim of this study was to test whether BNP could predict clinical prognosis in patients with end-stage renal failure on HD.
Methods: Plasma BNP levels were measured consecutively in 514 patients with end-stage renal failure treated with HD. Data were analyzed by grouping the patients into quartiles according to plasma BNP levels; Quartile 1 (Q1): < 145 ng/L, Quartile 2 (Q2): 145 to 266 ng/L, Quartile 3 (Q3): 267 to 628 ng/L, and Quartile 4 (Q4): > 628 ng/L. Cox models were used to evaluate the relationship between baseline BNP levels and the primary endpoints of cardiac events defined as cardiovascular events and mortality.
Results: All patients were followed up for 6 years. Frequency of cardiovascular events during follow-up period was found in 36.7% of Q1, in 44.2% of Q2, in 51.9% of Q3 and in 70.5 % of Q4 (p < 0.0001) (Table⇓). Mortality was 10.9% in Q1, 15.5% in Q2, 20.9% in Q3 and 33.3% in Q4 (p > 0.0001). Cox proportional hazards models showed that plasma BNP levels were the strongest correlate of cardiac events (adjusted hazard ratio, 2.96 [95% confidence interval: 2.07 to 4.23] for Q4 versus Q1) and mortality (adjusted hazard ratio, 2.10 [95% confidence interval: 1.72 to 2.56]) for Q4 versus Q1).
Conclusions: In patients on chronic maintenance HD, an elevated concentration of plasma BNP levels may be a good prognostic marker of adverse outcome by cardiac events and mortality. This method is quite simple and a useful adjunctive measurement to reduce medical expenses.