Background: Amino-terminal B-type natriuretic peptide (NT-proBNP) quantification is a useful cardiovascular diagnostic and prognostic test. In renal failure its use may have constraints, as it depends on renal clearance. We aimed to evaluate the clinical usefulness of NT-proBNP in hemodialysis (HD) patients. Methods: We measured NT-proBNP levels in 44 patients before and after a regular high-flux HD. Cardiac parameters were evaluated by echocardiography. Patients were followed up for 656.5 ± 476.4 days for the occurrence of hospital admission or death. Results: NT-proBNP levels decreased after HD (p < 0.0001) without correlation with ultrafiltration volume, Kt/V index, weight decrease or pulse pressure decrease. Pre- and post-HD NT-proBNP were similar in patients with and without left ventricular hypertrophy. Pre-HD levels were not significantly associated with prognosis, probably due to a type 2 error; post-HD NT- proBNP and NT-proBNP reduction ratio (RR) were predictive of the outcome by Kaplan-Meier analysis, but only RR remained associated with prognosis on multivariate regression analysis (hazard ratio 0.96; 95% confidence interval 0.93–0.99). Conclusion: Our results do not support the use of NT-proBNP in the diagnosis of left ventricular hypertrophy or volume status in HD patients, but suggest its utility in prognostic stratification. HD-related variation in NT-proBNP was associated with prognosis.

Keywords:
End-stage renal disease, Hemodialysis, Left ventricular hypertrophy, NT-proBNP, Prognosis
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2009
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