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Diagnostic value of B ‐type natriuretic peptide for estimating left atrial size and its usefulness for predicting all‐cause mortality and cardiovascular events among chronic haemodialysis patients
Author(s) -
Ishigami Junichi,
Iimori Soichiro,
Kuwahara Michio,
Sasaki Sei,
Tsukamoto Yusuke
Publication year - 2014
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12329
Subject(s) - medicine , natriuretic peptide , cardiology , ejection fraction , hazard ratio , heart failure , left atrial enlargement , confidence interval , receiver operating characteristic , dialysis , atrial fibrillation , sinus rhythm
Aim Estimating fluid balance in haemodialysis patients is essential when determining dry weight, but limited methods are currently available. B ‐type natriuretic peptide ( BNP) is a useful surrogate marker in patients with congestive heart failure ( CHF ), but whether its validity could be generalized to haemodialysis patients has not been studied well. Methods A total of 457 haemodialysis patients at a dialysis centre were analyzed. Determinants of BNP were assessed in connection with ultrasound cardiography ( UCG ) records, K t/ V , ultrafiltration rate ( UFR ), and demographic factors. All‐cause death and cardiovascular ( CV ) events were recorded as the main outcome. Results Among the UCG records, left atrial diameter ( LAD ), left ventricular ejection fraction ( LVEF ), were determinants of log‐transformed (ln) BNP ; UFR , age and sex were also significant. There was a positive correlation between BNP and LAD (r = 0.285, P < 0.001). Receiver operating characteristic ( ROC ) analysis revealed that BNP had 90% and 80% sensitivity to predict the presence of LA enlargement of 77.9 pg/mL and 133.2 pg/mL, respectively. Higher BNP and lower LVEF were associated with higher risk for developing all‐cause death and CVD . In the adjusted model, patients with BNP higher than 471 pg/mL had hazard ratio of 2.18 (95% confidence interval ( CI ) 1.20–3.96, P = 0.01), compared to those with BNP <109 pg/mL. Conclusion B ‐type natriuretic peptide was determined by LAD , LVEF , UFR , age and sex. BNP and LAD had positive correlation and BNP could become a useful tool for estimating the presence of LA enlargement. BNP and LVEF was a strong risk factor for predicting all‐cause death and CV events among patients undergoing haemodialysis.