RESUMEN
This study aimed to assess cardiac troponin T (cTnT) and hydration state as cardiovascular (CV) risk markers in hemodialysis (HD) patients. Two hundred and forty one patients were divided according to HD vintage into two groups: SV (HD ≤24 months) and LV. Water balance was assessed with overhydration (OH%; bioimpedance analysis) and daily diuresis (DD); CV dysfunction with cTnT and heart ultrasound; nutrition with subjective global assessment (SGA), cholesterol (TC) and albumin. SV had lower OH% (2.8 vs. 3.5, p < 0.05) and higher DD (1,161 vs. 637 ml, p < 0.001), while LV had higher cTnT (0.1 ± 0.04 vs. 0.1 ± 0.07 ng/ml, p < 0.05) and lower interventricular septum thickness (IVS; 13.4 vs. 14.5 mm, p < 0.05). Nutritional state as reflected by lower TC was worse in LV (184.7 vs. 169.5 mg/dl, p < 0.05). Mortality was higher in patients in the LV group (15 vs. 27 deaths, p < 0.05). OH% correlated inversely with albumin (r = -0.36, p < 0.001), TC (r = -0.31, p < 0.001) and cTnT (r = -0.4, p < 0.001). cTnT correlated positively with IVS (r = 0.39, p < 0.001), SGA (r = 0.23, p = 0.001) and mortality rate (r = 0.21, p < 0.01), and negatively with DD (r = -0.34, p < 0.001) and albumin (r = -0.25, p < 0.001). Longer dialysis vintage associates with CV dysfunction, overhydration and increased mortality, which may be predicted with OH% and cTnT. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=376603.
Asunto(s)
Enfermedades Cardiovasculares/sangre , Fallo Renal Crónico/sangre , Diálisis Renal/métodos , Troponina T/sangre , Equilibrio Hidroelectrolítico , Anciano , Biomarcadores/sangre , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/terapia , Colesterol/sangre , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estado Nutricional , Pronóstico , Diálisis Renal/mortalidad , Factores de Riesgo , Albúmina Sérica/metabolismo , Análisis de SupervivenciaRESUMEN
INTRODUCTION: Nterminal proBtype natriuretic peptide (NTproBNP) is an established biomarker of heart failure in the general population. However, its diagnostic value is unclear in hemodialysis (HD) patients owing to renal insufficiency. OBJECTIVES: The aim of the study was to establish the usefulness of NTproBNP for hydration assessment and the relation of NTproBNP to the nutritional state and prognosis of survival. PATIENTS AND METHODS: In 321 HD patients (206 men; mean age, 65.1 ±21.4 years), we assessed NTproBNP levels, overhydration (OHBIA), and the indices of the nutritional state (using a bioimpedance analysis [BIA]) in relation to cardiac troponin T (cTnT), hemoglobin, albumin, total cholesterol (TC), and Creactive protein (CRP) levels. The efficacy of HD was assessed using Kt/V, weekly HD dose, and HD session ultrafiltration. The cohort was divided into NTproBNP quartiles. Patients with 2 NTproBNP measurements were categorized also into changeovertime subgroups. A followup lasted for a median period of 23.8 ±26.3 months. RESULTS: Relative OHBIA increased across the NTproBNP quartiles (Q1/Q2/Q3/Q4, 1.31% ±2.56%/2.06% ±2.35%/2.92% ±2.97%/4.62% ±4.22%; P <0.0001). NTproBNP was also closely associated with other OH parameters. In addition, there was a significant correlation between NTproBNP and cTnT (r = 0.55; P <0.0001). Body mass index (BMI) and fat tissue index (FTI) decreased across the quartiles (BMI, 28.5 ±7.7/26.0 ±6.6/25.8 ±5.4/23.7 ±5.5 kg/m2; FTI, 14.4 ±9.0/14.1 ±7.3/12.3 ±6.8/11.6 ±6.1; P <0.001). The highest albumin level was present in Q1 (4.10 ±0.63/3.99 ±0.51/3.90 ±0.62/3.97 ±0.78 g/dl; P = 0.006). The TC level was the lowest in Q4 (190 ±60/169 ±56/173 ±51/153 ±56 mg/dl; P = 0.002). The hemoglobin level decreased across the quartiles (11.44 ±1.25/11.15 ±2.50/10.79 ±1.51/10.45 ±1.67 g/dl; P = 0.0006). The differences in CRP levels and HDrelated parameters were nonsignificant. During the followup, 97 deaths were recorded (11/26/21/39, P <0.0001). CONCLUSIONS: NTproBNP seems to be a useful biomarker of hypervolemia in HD patients. Nevertheless, it has to be interpreted with regard to the patient's individual residual renal function and cardiovascular status.