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B-type Natriuretic Peptides Strongly Predict Mortality in Patients Who Are Treated with Long-Term Dialysis

Matthew A. Roberts^*,, Piyush M. Srivastava^,, Neil Macmillan, David L. Hare^,, Sujiva Ratnaike^,, Ken Sikaris^||, and Francesco L. Ierino^*,

Departments of ^* Nephrology, Cardiology, and Pathology, Austin Health, Department of Medicine, University of Melbourne, and ^|| Melbourne Pathology Service, Melbourne, Victoria, Australia

Correspondence: Dr. Matthew A. Roberts, Department of Nephrology, Austin Health, P.O. Box 5555, Heidelberg 3084, Australia. Phone: +61-3-94965634; Fax: +61-3-94965123; E-mail: matthew.roberts{at}austin.org.au

Background and objectives: Left ventricular abnormalities contribute to cardiovascular disease in patients with chronic kidney disease and may be detected by measurement of B-type natriuretic peptide in serum.

Design, setting, participants, & measurements: In a prospective cohort study of predialysis patients, patients who were on dialysis, and kidney transplant recipients, serum was collected and assayed for both B-type natriuretic peptide and its N-terminal fragment. Median levels were compared using nonparametric tests, and predictors of B-type natriuretic peptide were determined by linear regression. Survival analysis and Cox regression were performed to examine the association of levels of B-type natriuretic peptide with cardiovascular events and death.

Results: Levels of B-type natriuretic peptide were highest in patients who were on dialysis. Patients who were receiving dialysis and had known cardiovascular disease, were not on the waiting list for kidney transplantation, or had left ventricular systolic dysfunction on echocardiography had significantly higher levels of B-type natriuretic peptide than patients without these characteristics. Glomerular filtration rate was an important predictor of B-type natriuretic peptide levels for patients who were not on dialysis (predialysis and renal transplant recipients). Left ventricular systolic dysfunction predicted B-type natriuretic peptide levels in patients who were on dialysis. Both forms of B-type natriuretic peptide were associated with a two- to three-fold increased risk for death in patients who were on dialysis.

Conclusions: Levels of B-type natriuretic peptide are greatest in patients who are on dialysis and have cardiovascular comorbidities and are strong predictors of death.