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Predictive Value of Brain Natriuretic Peptides in Patients on Peritoneal Dialysis: Results from the ADEMEX Trial

Ramon Paniagua^*, Dante Amato^*, Salim Mujais, Edward Vonesh, Alfonso Ramos, Ricardo Correa-Rotter^||, and Walter H. Horl^¶

For the Mexican Nephrology Collaborative Study Group, ^* Unidad de Investigacioñ Médica en Enfermedades Nefrolìicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Astellas Pharma US, Deerfield, Illinois; Northwestern University, Evanston, Illinois; Instituto Mexicano del Seguro Social, Hermosillo, Mexico; ^|| Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico; and ^¶ Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria

Correspondence: Dr. Salim Mujais, 2742 The Mews, Northbrook, IL 60062. Phone: 847-317-5468; Fax: 847-317-8861; E-mail: salim.mujais{at}gmail.com

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 60L/wk/1.73 m²; 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.