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. 2018 Aug 22;13(8):e0202733.
doi: 10.1371/journal.pone.0202733. eCollection 2018.

The interaction between N-terminal pro-brain natriuretic peptide and fluid status in adverse clinical outcomes of late stages of chronic kidney disease

Yi-Chun Tsai  1   2   3 , Hui-Ju Tsai  4 , Chee-Siong Lee  1   5 , Yi-Wen Chiu  2   3 , Hung-Tien Kuo  2   3 , Su-Chu Lee  2 , Tzu-Hui Chen  6 , Mei-Chuan Kuo  2   3
Affiliations

The interaction between N-terminal pro-brain natriuretic peptide and fluid status in adverse clinical outcomes of late stages of chronic kidney disease

Yi-Chun Tsai et al. PLoS One. .

Abstract

Introduction: Fluid overload is one of the major characteristics and complications in patients with chronic kidney disease (CKD). N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to fluid status and fluid distribution. The aim of this study is to investigate the interaction between NT-proBNP and fluid status in adverse clinical outcomes of late stages of CKD.

Methods: We enrolled 239 patients with CKD stages 4-5 from January 2011 to December 2011 and followed up until June 2017. Fluid status was presented as hydration status (HS) value measured by body composition monitor, while HS>7% was defined as fluid overload. Clinical outcomes included renal outcomes (commencing dialysis and estimated glomerular filtration rate decline>3 ml/min/1.73 m2/year), all-cause mortality and major adverse cardiovascular events (MACEs).

Results: During a mean follow-up of 3.3±2.0 years, 129(54.7%) patients commenced dialysis, 88(37.3%) patients presented rapid renal function decline, and 48(20.3%) had MACEs or died. All patients were stratified by HS of 7% and the median of plasma NT-proBNP. The adjusted risks for commencing dialysis was significantly higher in patients with high plasma NT-proBNP and HS>7% compared to those with low plasma NT-proBNP and HS≦7%. There was a significant interaction between plasma NT-proBNP and HS in commencing dialysis (P-interaction = 0.047). Besides, patients with high plasma NT-proBNP and HS>7% had greater risks for MACEs or all-cause mortality than others with either high plasma NT-proBNP or HS>7%.

Conclusion: NT-proBNP and fluid overload might have a synergistic association of adverse clinical outcomes in patients with late stages of CKD.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The correlation between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and fluid status.
Fig 2
Fig 2
Kaplan-Meier survival curve for (A) commencing dialysis and (B) major adverse cardiovascular events or all-cause mortality in study subjects stratified by plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and fluid status.
Fig 3
Fig 3
The association of eGFR decline with (A) fluid status and (B) plasma N-terminal pro-brain natriuretic peptide (NT-proBNP).
See this image and copyright information in PMC

References

    1. Takami Y, Horio T, Iwashima Y, Takiuchi S, Kamide K, Yoshihara F, et al. Diagnostic and prognostic value of plasma brain natriuretic peptide in non-dialysis-dependent CRF. Am J Kidney Dis. 2004; 44(3): 420–428. - PubMed
    1. Panteghini M, Clerico A. Understanding the clinical biochemistry of N-terminal pro-B-type natriuretic peptide: The prerequisite for its optimal clinical use. Clin Lab. 2004; 50(5–6): 325–331. - PubMed
    1. Kamano C, Osawa H, Hashimoto K, Nishimura S, Saito SK, Kashiwagi T, et al. N-Terminal pro-brain natriuretic peptide as a predictor of heart failure with preserved ejection fraction in hemodialysis patients without fluid overload. Blood Purif. 2012; 33(1–3): 37–43. 10.1159/000333841 - DOI - PubMed
    1. Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature. 1988; 332(6159): 78–81. 10.1038/332078a0 - DOI - PubMed
    1. Khan I, AFink J, Nass C, Chen H, Christenson R, deFilippi CR. N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide for identifying coronary artery disease and left ventricular hypertrophy in ambulatory chronic kidney disease patients. Am J Cardiol. 2006; 97(10): 1530–1534. 10.1016/j.amjcard.2005.11.090 - DOI - PubMed

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