Samar Abd ElHafeez1, Giovanni Tripepi2, Benedetta Stancanelli3, Evangelia Dounousi4, Lorenzo Malatino3, Francesca Mallamaci2, Carmine Zoccali2. 1. Epidemiology Department, High Institute of Public Health, Alexandria University, 165 Elhorreya Avenue, Elhadara, Alexandria, Egypt. samarabdelhafeez.epid@gmail.com. 2. CNR-IFC/IBIM Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension, Reggio Calabria, Italy. 3. Clinica Medica Università di Catania Ospedale Cannizzaro, Catania, Italy. 4. School of Health Sciences, University of Ioannina, Ioannina, Greece.
Abstract
BACKGROUND: Sympathetic over-activity is a hallmark of end stage renal disease (ESRD). Left ventricular (LV) disorders and volume overload are pervasive in ESRD and sympathetic over-activity may be a relevant mediator of the cardiovascular (CV) risk by these alterations in this population. DESIGN: We investigated the relationship between a combined biomarker of LV disorders and volume excess, atrial natriuretic peptide (ANP), and the plasma concentration of nor-epinephrine (NE) in 227 ESRD patients without heart failure at baseline and modelled the risk for incident CV events by these biomarkers over a 3.5 years follow-up. RESULTS: Plasma NE was strongly and independently related to ANP (β = 0.31, P < 0.001). In a multivariate Cox's regression analysis, ANP was an independent predictor of these events [HR (1-SD) 1.25, 95 % CI 1.01-1.54]. However, when NE was introduced into the multivariate model, HR by ANP reduced substantially (1.14, 95% CI 0.91-1.42) and was no longer significant (P = 0.25) while the CV risk signalled by NE was clinically relevant (HR 1.29, 95% CI 1.05-1.59) and statistically significant (P = 0.02). CONCLUSIONS: In ESRD patients without heart failure, NE is strongly and independently related to ANP. The predictive power of ANP for CV events is largely captured by NE in a statistical model including both biomarkers. These data suggest that sympathetic over-activity may be a relevant mediator of the high risk of CV events triggered by LV disorders and volume excess in this population. However, further mechanistic and intervention studies are needed to prove the nature (causal/non causal) of these findings.
BACKGROUND: Sympathetic over-activity is a hallmark of end stage renal disease (ESRD). Left ventricular (LV) disorders and volume overload are pervasive in ESRD and sympathetic over-activity may be a relevant mediator of the cardiovascular (CV) risk by these alterations in this population. DESIGN: We investigated the relationship between a combined biomarker of LV disorders and volume excess, atrial natriuretic peptide (ANP), and the plasma concentration of nor-epinephrine (NE) in 227 ESRDpatients without heart failure at baseline and modelled the risk for incident CV events by these biomarkers over a 3.5 years follow-up. RESULTS: Plasma NE was strongly and independently related to ANP (β = 0.31, P < 0.001). In a multivariate Cox's regression analysis, ANP was an independent predictor of these events [HR (1-SD) 1.25, 95 % CI 1.01-1.54]. However, when NE was introduced into the multivariate model, HR by ANP reduced substantially (1.14, 95% CI 0.91-1.42) and was no longer significant (P = 0.25) while the CV risk signalled by NE was clinically relevant (HR 1.29, 95% CI 1.05-1.59) and statistically significant (P = 0.02). CONCLUSIONS: In ESRDpatients without heart failure, NE is strongly and independently related to ANP. The predictive power of ANP for CV events is largely captured by NE in a statistical model including both biomarkers. These data suggest that sympathetic over-activity may be a relevant mediator of the high risk of CV events triggered by LV disorders and volume excess in this population. However, further mechanistic and intervention studies are needed to prove the nature (causal/non causal) of these findings.
Entities:
Keywords:
Cardiovascular; ESRD; LV dysfunction; Left ventricular disorders; Nor epinephrine; Sympathetic; Volume expansion
Authors: Giovanni Tripepi; Francesco Mattace-Raso; Francesca Mallamaci; Francesco Antonio Benedetto; Jacqueline Witteman; Lorenzo Malatino; Carmine Zoccali Journal: Hypertension Date: 2009-07-27 Impact factor: 10.190
Authors: Carmine Zoccali; Francesco A Benedetto; Francesca Mallamaci; Giovanni Tripepi; Giuseppe Giacone; Alessandro Cataliotti; Giuseppe Seminara; Benedetta Stancanelli; Lorenzo S Malatino Journal: J Am Soc Nephrol Date: 2004-04 Impact factor: 10.121
Authors: Maria Fernanda Carrasco-Ruiz; Antonio Ruiz-Rivera; Marvin A Soriano-Ursúa; Carlos Martinez-Hernandez; Leticia Manuel-Apolinar; Carmen Castillo-Hernandez; Gustavo Guevara-Balcazar; Eunice D Farfán-García; Ana Mejia-Ruiz; Ivan Rubio-Gayosso; Teresa Perez-Capistran Journal: World J Cardiol Date: 2022-04-26