Neurohumoral activity, heart failure and prognosis in patients with end-stage renal disease treated by hemodialysis

Abstract

Background: Chronic renal failure treated by regular hemodialysis is frequently accompanied by chronic heart failure; the mortality of both is high.

Aim: To evaluate the role of markers of neurohumoral activation for the prognosis of patients treated with regular dialysis.

Patients: 99 patients with end-stage renal disease were followed up for 3 years.

Methods: Clinical evaluation, echocardiography, biochemistry including NT-proBNP and big endothelin (Big-ET).

Results: The incidence of heart failure was 97% and the 3-year mortality was 50%. The sensitivity of NT-proBNP and Big-ET level for the prediction of death was 0.712 and 0.824, respectively, and specificity 0.642 and 0.695, respectively. The cut-off points were NT-proBNP > or = 2,000 pg/ml and Big-ET > or = 1.55 pmol/l. Neither NT-proBNP nor Big-ET could be incorporated in the multivariate model for overall survival, which means that although both parameters significantly influenced overall survival as single risk factors, they were not effective in competition with the other significant predictors.

Conclusion: Overall survival seems to be influenced namely by age, hemoglobin, left atrium diameter or pulmonary congestion class on chest X-ray, while probability of early risk was associated with Big-ET, history of diabetes mellitus, C-reactive protein, uric acid and hemoglobin. The only intersection of the models is hemoglobin as a thoroughly significant predictor.