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Randomized Controlled Trial
. 2008 Mar;3(2):407-15.
doi: 10.2215/CJN.03820907. Epub 2008 Jan 16.

Predictive value of brain natriuretic peptides in patients on peritoneal dialysis: results from the ADEMEX trial

Ramon Paniagua  1 , Dante Amato, Salim Mujais, Edward Vonesh, Alfonso Ramos, Ricardo Correa-Rotter, Walter H Horl
Affiliations
Randomized Controlled Trial

Predictive value of brain natriuretic peptides in patients on peritoneal dialysis: results from the ADEMEX trial

Ramon Paniagua et al. Clin J Am Soc Nephrol. 2008 Mar.

Abstract

Background and objectives: Natriuretic peptides have been suggested to be of value in risk stratification in dialysis patients. Data in patients on peritoneal dialysis remain limited.

Design, setting, participants, & measurements: Patients of the ADEMEX trial (ADEquacy of peritoneal dialysis in MEXico) were randomized to a control group [standard 4 x 2L continuous ambulatory peritoneal dialysis (CAPD); n = 484] and an intervention group (CAPD with a target creatinine clearance > or =60 L/wk/1.73 m(2); n = 481). Natriuretic peptides were measured at baseline and correlated with other parameters as well as evaluated for effects on patient outcomes.

Results: Control group and intervention group were comparable at baseline with respect to all measured parameters. Baseline values of natriuretic peptides were elevated and correlated significantly with levels of residual renal function but not with body size or diabetes. Baseline values of N-terminal fragment of B-type natriuretic peptide (NT-proBNP) but not proANP(1-30), proANP(31-67), or proANP(1-98) were independently highly predictive of overall survival and cardiovascular mortality. Volume removal was also significantly correlated with patient survival.

Conclusions: NT-proBNP have a significant predictive value for survival of CAPD patients and may be of value in guiding risk stratification and potentially targeted therapeutic interventions.

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Figures

Figure 1.
Figure 1.
Patient overall survival (all cause mortality) by N-terminal pro-brain natriuretic peptide (NT-proBNP) and treatment assignment. The control (control) and the intervention (Treatment) groups were divided based on the median value of NT-proBNP. NT-proBNP had a significant effect on survival (P < 0.001) that was independent of the treatment assignment.
Figure 2.
Figure 2.
Patient cardiovascular survival (cardiovascular mortality) by N-terminal pro-brain natriuretic peptide (NT-proBNP) and treatment assignment. The control (control) and the intervention (Treatment) groups were divided based on the median value of NT-proBNP. NT-proBNP had a significant effect on survival (P < 0.001) that was independent of the treatment assignment.
Figure 3.
Figure 3.
Patient overall survival (all cause mortality) by pro-atrial natriuretic peptide proANP(1-98) and treatment assignment. The control (control) and the intervention (Treatment) groups were divided based on the median value of proANP(1-98). ProANP(1-98) had no effect on survival in either treatment assignment groups.
Figure 4.
Figure 4.
Patient overall survival (all cause mortality) by total fluid removal (urinary and peritoneal) and treatment assignment. Groups were divided based on a value of fluid removal identified in the European Automated Peritoneal Dialysis Study (EAPOS) as correlated with survival (35). Total fluid removal (Vol) had a significant effect on survival (P < 0.01) that was independent of the treatment assignment.
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