Clinical significance of N-terminal Pro-B-type natriuretic peptide (NT-proBNP) in hemodialysis patients.

Circulating biomarkers play a major role in the early detection of cardiovascular disease. The purpose of this study was to determine levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in hemodialysis (HD) patients and to examine the relationship of this marker to left ventricular hypertrophy and to cardiac dysfunction. Plasma NT-proBNP concentrations were measured in patients undergoing chronic HD, who did not any clinical evidence of heart failure, (n=32; mean age 43.14 +/- 12 years; sex-ratio 1.8) as well as healthy volunteers (n=32; mean age 45.84 +/- 1.9 years; sex-ratio 1). In addition, the correlation between plasma NT-proBNP concentration and parameters of echocardiography was examined. The plasma NT-proBNP levels in the HD patients were significantly higher (14422.6 +/- 13757.8 pg/mL) than those in healthy volunteers (39.21 pg/mL) (P< 10 -3 ). In addition, the area under the receiver operating characteristic curve (ROC) revealed that the cut-off level of NT-proBNP was 288 pg/mL. On univariate analysis, the plasma NT-proBNP concentrations, in patients on HD, correlated positively with age (P= 0.004; r=0.5), systolic (P= 0.046; r= 0.36) and diastolic blood pressures (P= 0.037; r= 0.37), residual diuresis (P= 0.09; r= 0.3), the left atrial diameter (LAD) (P= 0.006; r= 0.55), left ventricular mass index (LVMI) (P= 0.01; r= 0.44) and negatively with albumin (P= 0.01; r= -0.44). However, there was no correlation between plasma levels of NT-proBNP and gender, body mass index (BMI), mean period on dialysis, pulse pressure, dry weight and left ventricular dysfunction. On multivariate analysis, only age (P= 0.014, RR= 2.8) was associated with significantly increased levels of NT-proBNP. Further studies are needed to carefully assess the diagnostic accuracy and prognostic value of NT-proBNP in patients on HD.