Relationship of malnutrition, n-terminal pro-b-type natriuretic peptide and ventricular remodeling in patients on maintenance hemodialysis

The aim of the present study was to investigate the relationship among nutritional status, N-terminal probrain-type natriuretic peptide (NT–proBNP) and ventricular remodeling in hemodialysis (HD) patients. Serum concentrations of NT-proBNP were measured by immunoassay. Nutritional status was assessed using the subjective global assessment (SGA) score and malnutrition–inflammation score (MIS). Echocardiographic examinations were performed on all patients. Forty-four patients undergoing maintenance HD were enrolled in this study. Malnourished patients, assessed according to SGA, had higher levels of extracellular water (ECW) per kg body weight (BWt) than well-nourished patients (mean, 0.30 vs 0.26 l/ kg, respectively) and higher levels of NT-proBNP (median, 24,807 vs 4,342  pg/ml, respectively). MIS was positively correlated with left ventricular mass index (LVMI), log NT–proBNP and ECW/BWt (r =0.35, 0.45 and 0.38), and negatively correlated with fat mass and LV systolic dysfunction (r=–0.41 and –0.32). LV systolic dysfunction, LVMI and MIS were associated with log NT-proBNP levels. Multiple regression analysis showed that log NT–proBNP, mean arterial pressure and ECW/BWt were independently associated with LVMI.In conclusion, malnutrition in HD patients is accompanied by volume overload and associated with increased log NT–proBNP levels independent of volume status, and these levels are independently associated with increased LVMI. This suggests that malnutrition may affect ventricular remodeling or dysfunction in HD patients