Abstract 13529: Association of B-Type Natriuretic Peptide and C-Reactive Protein with Cardiovascular and All-cause Mortality in Chronic Hemodialysis Patients — 10-year prospective study
Background: It has been established that elevated B-Type natriuretic peptide (BNP) and C-reactive protein (CRP) levels are associated with poor cardiovascular (CV) prognosis, respectively. We investigated the association of BNP, CRP and their joint role with prediction of long-term CV and all-cause mortality in hemodialysis (HD) patients who are widely recognized to be at a high CV risk.
Methods: Plasma BNP and serum CRP levels were measured consecutively in 500 patients undergoing HD. The patients were divided into 4 groups according to plasma BNP levels; Quartile 1 (Q1): < 145 ng/L, Q2: 145–266 ng/L, Q3: 267–628 ng/L and Q4: > 628 ng/L, and also on serum CRP levels; Q1: <0.9 mg/l, Q2: ≥0.9 and <2.7 mg/l, Q3: ≥2.7 and <11.7mg/l and Q4: ≥11.7mg/l, respectively. All patients were prospectively followed up for 10 years.
Results: Plasma BNP levels were higher according to CRP levels elevate (339±382ng/l, 474±452ng/l, 573±803ng/l and 711±1243ng/l in Q1, Q2, Q3 and Q4 of CRP, p=0.0024, respectively). During follow-up period (80±41months), 204 patients (40.8%) died including 95 CV deaths (19.0%). Adjusted hazard ratio (HR) of elevated BNP levels was 2.65 (95%CI 1.28–5.50 for Q4 vs. Q1, p=0.0089) for CV mortality and 2.40 (95%CI 1.47–3.90 for Q4 vs. Q1, p=0.0020) for all-cause mortality, respectively. Similarly, adjusted HR of elevated CRP levels was 4.20 (95%CI 1.95–9.07, p=0.0002) for CV mortality and 4.11 (95%CI 2.36–7.15, p<0.0001) for all-cause mortality, respectively. In the joint setting of BNP and CRP, the risk of CV mortality was 20.3-fold in the highest quartile on both BNP and CRP compared with the lowest quartile on both BNP and CRP even after adjustment (p=0.0034). Similarly, the risk of all-cause mortality was 18.8-fold (p<0.0001) (Figure).
Conclusions: Elevated BNP and CRP levels might be closely associated, and the combination of these variables is more markedly related to increased mortality than either variable alone in HD patients.
- © 2010 by American Heart Association, Inc.