Mattia Arrigo1, Seraina Von Moos2, Kerem Gerritsen2, Malha Sadoune3, Kamonwan Tangvoraphonkchai4,5, Andrew Davenport4, Alexandre Mebazaa3,6, Stephan Segerer2,7, Pietro E Cippà2,8. 1. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. 2. Department of Nephrology, University Hospital Zurich, Zurich, Switzerland. 3. INSERM UMR-S 942, Paris, France. 4. UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK. 5. Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand. 6. Department of Anesthesiology and Critical Care Medicine, St Louis and Lariboisère University Hospitals, Paris, France. 7. Department of Nephrology, Kantonsspital Aarau, Aarau, Switzerland. 8. Center for Regenerative Medicine and Stem Cell Research, University of Southern California, Los Angeles, CA, USA.
Abstract
Background: Accurate volume status evaluation and differentiation of cardiac and non-cardiac components of overhydration (OH) are fundaments of optimal haemodialysis (HD) management. Methods: This study, by combining bioimpedance measurements, cardiovascular biomarkers and echocardiography, aimed at dissecting OH into its major functional components, and prospectively tested the association between cardiac and non-cardiac components of OH with mortality. In the first part, we validated soluble CD146 (sCD146) as a non-cardiac biomarker of systemic congestion in a cohort of 30 HD patients. In the second part, we performed a prospective 1-year follow-up study in an independent cohort of 144 HD patients. Results: sCD146 incrementally increased after the short and long intervals after HD (+53 ng/mL, P = 0.006 and +91 ng/mL, P < 0.001), correlated with OH as determined by bioimpedance and well-diagnosed OH (area under the receiver operating characteristics curve 0.72, P = 0.005). The prevalence of OH was lower for low-sCD146 and low-BNP patients (B-type natriuretic peptide, 29%) compared with subjects with either one or both biomarkers elevated (65-74%, P < 0.001). Notably, most low-BNP but high-sCD146 subjects were overhydrated. Systolic dysfunction was 2- to 3-fold more prevalent among high-BNP compared with low-BNP patients (44-68% versus 21-23%, chi-square P < 0.001), regardless of sCD146. One-year all-cause mortality was markedly higher in patients with high-BNP (P = 0.001) but not with high-sCD146. In multivariate analysis, systolic dysfunction and BNP, but not OH, were associated with lower survival. Conclusions: The combination of BNP and sCD146 dissects OH into functional components of prognostic value. OH in HD patients is associated with higher mortality only if resulting from cardiac dysfunction.
Background: Accurate volume status evaluation and differentiation of cardiac and non-cardiac components of overhydration (OH) are fundaments of optimal haemodialysis (HD) management. Methods: This study, by combining bioimpedance measurements, cardiovascular biomarkers and echocardiography, aimed at dissecting OH into its major functional components, and prospectively tested the association between cardiac and non-cardiac components of OH with mortality. In the first part, we validated soluble CD146 (sCD146) as a non-cardiac biomarker of systemic congestion in a cohort of 30 HDpatients. In the second part, we performed a prospective 1-year follow-up study in an independent cohort of 144 HDpatients. Results: sCD146 incrementally increased after the short and long intervals after HD (+53 ng/mL, P = 0.006 and +91 ng/mL, P < 0.001), correlated with OH as determined by bioimpedance and well-diagnosed OH (area under the receiver operating characteristics curve 0.72, P = 0.005). The prevalence of OH was lower for low-sCD146 and low-BNPpatients (B-type natriuretic peptide, 29%) compared with subjects with either one or both biomarkers elevated (65-74%, P < 0.001). Notably, most low-BNP but high-sCD146 subjects were overhydrated. Systolic dysfunction was 2- to 3-fold more prevalent among high-BNP compared with low-BNPpatients (44-68% versus 21-23%, chi-square P < 0.001), regardless of sCD146. One-year all-cause mortality was markedly higher in patients with high-BNP (P = 0.001) but not with high-sCD146. In multivariate analysis, systolic dysfunction and BNP, but not OH, were associated with lower survival. Conclusions: The combination of BNP and sCD146 dissects OH into functional components of prognostic value. OH in HDpatients is associated with higher mortality only if resulting from cardiac dysfunction.
Authors: Mattia Arrigo; Nicolas Vodovar; Seraina Von Moos; Elisabeth Masson; Stephan Segerer; Pietro E Cippà; Alexandre Mebazaa Journal: J Clin Lab Anal Date: 2018-05-23 Impact factor: 2.352
Authors: Wouter C Meijers; Antoni Bayes-Genis; Alexandre Mebazaa; Johann Bauersachs; John G F Cleland; Andrew J S Coats; James L Januzzi; Alan S Maisel; Kenneth McDonald; Thomas Mueller; A Mark Richards; Petar Seferovic; Christian Mueller; Rudolf A de Boer Journal: Eur J Heart Fail Date: 2021-10-10 Impact factor: 17.349