B-type Natriuretic Peptide as a Predictor of Cardiovascular Disease in End-Stage Renal Disease Patients Commencing Hemodialysis

Kim, Su Hee; Lee, Eun Kyeong; Chang, Jai Won; Yang, Won Seok; Kim, Soon Bae; Lee, Sang Koo; Park, Su Kil; Park, Jung Sik

Abstract

BACKGROUND
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in end- stage renal disease (ESRD) patients. The early diagnosis and treatment of CVD could improve survival in dialysis patients. The plasma level of B-type Natriuretic Peptide (BNP) correlates with the severity of LV dysfunction and increases following myocardial ischemia. We investigated the ability of BNP as a predictor of CVD in new ESRD patients whose volume overload status were not corrected. METHODS: CVD was defined as an LV ejection fraction <45% or a positive myocardial SPECT. We measured plasma levels of BNP in 79 new ESRD patients requiring hemodialysis (HD) and investigated the relationships between BNP levels and echocardiography and myocardial SPECT. RESULTS: Median concentrations of BNP were higher in 16 patients with heart failure than those in 63 patients without heart failure (1, 748.5 vs. 127.0 pg/mL, p<0.001) and higher in 12 patients with positive myocardial SPECT than those in 67 patients with negative SPECT (1, 160.5 vs. 129.0 pg/mL, p< 0.001). BNP levels were higher in 23 patients with CVD than those in 56 patients without CVD (1, 234.0 vs. 119.0 pg/mL, p<0.001). There was an inverse correlation between BNP and LV ejection fraction (r=-0.65, p<0.001). The present study demonstrated a significant 34.9% increment of cardiac mortality by the every increase of 100 pg/mL of BNP. The negative predictive value of BNP for excluding CVD was 89.3% (cut-off value, 500 pg/mL). CONCLUSION: Our findings suggest that BNP could be an effective screening test for the evaluation of the presence of CVD in ESRD patients starting maintenance HD.